What WorkSafe will pay for

The WorkSafe Agent (the Agent) can pay the reasonable costs of the Post-Traumatic Stress Disorder Group Treatment Program when required as a result of a workrelated injury or illness under Victorian workers compensation legislation (the legislation). 

Background 

The Post-Traumatic Stress Disorder (PTSD) Group Treatment Program is a time limited mental health outpatient service that the Agent can approve for workers who experience post traumatic psychological distress as a result of a work-related injury or illness. 

The PTSD Group Treatment Program aims to assist eligible workers by: 

  • reducing the burden of post-traumatic psychological distress 
  • facilitating access to timely and effective psychological treatment, and 
  • improving return to health and return to work outcomes. 

Following a Pre-Program Psychological Assessment a worker participates in a range of modules covering education, symptom management, skill development and return to work. 

A worker's partner or other first degree relative may be given the opportunity to be involved in an accompanying Partner and Family Support Module as this forms part of the injured worker's treatment. If required, accommodation may be arranged for a worker participating in the PTSD Group Treatment Program. 

Definitions 

In this policy:  

  • Post-Traumatic stress disorder is experienced as intrusive recollections, avoidance, numbing behaviours and arousal that may occur after being involved in a traumatic event as described in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V). 
  • Pre-Program Psychological Assessment is undertaken by a PTSD Group Treatment Program provider with the worker to determine suitability for entry into the program. It must be requested by a medical practitioner and requires prior approval from the Agent. 
  • Post-Traumatic Stress Disorder Group Treatment Program is a time limited mental health outpatient service. 
  • The Partner and Family Support Module is a support group delivered by the PTSD Group Treatment Program as a part of the injured worker's treatment for a first degree relative (such as a spouse/partner, adult child, sibling or parent) of a worker participating in the program. 

Guidelines 

What can the Agent pay for in relation to the PTSD Group Treatment Program? 

The Agent can pay the reasonable costs of the PTSD Group Treatment Program for workers who experience post-traumatic psychological distress as a result of a work-related injury or illness. 

The Agent can pay the reasonable costs of the following components of a PTSD Group Treatment Program where prior written approval has been obtained for each component: 

  • a Pre-Program Psychological Assessment when requested by a medical practitioner 
  • a Partner and Family Support Module for a partner or another first degree relative of the worker participating in a PTSD Group Treatment Program, on the recommendation of the provider 
  • a Partner and Family Support Module for a partner or another first degree relative of the worker participating in a PTSD Group Treatment Program, on the recommendation of the provider 
  • accommodation for a worker who is participating in a PTSD Group Treatment Program 
  • participation in a case conference 

Who can provide the PTSD Group Treatment Program? 

Each component of the PTSD Group Treatment Program can only be provided by either a public, denominational or private hospital (within the meaning of the Health Services Act 1988) which: 

  • specialises in providing comprehensive and clinically targeted mental health services for treating PTSD and associated post traumatic mental health conditions, and 
  • is registered and approved by WorkSafe to provide the PTSD Group Treatment Program to workers. 

What information does the Agent require to consider paying for the PTSD Group Treatment Program? 

Written approval from the Agent is required prior to the provision of any component associated with the PTSD Group Treatment Program. 

This includes the: 

  • delivery of a Pre-Program Psychological Assessment; 
  • delivery of a PTSD Group Treatment Program; 
  • delivery of a Partner and Family Support Module; and 
  • arrangement and/or use of accommodation for a worker participating in a PTSD Group Treatment Program. 

To facilitate a timely decision on a request for a PreProgram Psychological Assessment, the Agent requires a written request from a medical practitioner that includes: 

  • name of the worker 
  • home address of the worker 
  • current diagnosis 
  • occupation 
  • return to work status and goals 
  • historical or current use of prescription medications. 

The Agent requires the completion of a Pre-Program Psychological Assessment by the PTSD Group Treatment Program provider to determine a worker's suitability for entry into the program. 

The assessment report must be submitted to the Agent as soon as practicable and no later than 15 business days from completion of the assessment. A provider may also recommend to the Agent that the partner or first degree relative of the worker undertake a Partner and Family Support Module. 

When will the Agent respond to a request? 

  • Within 10 working days of receiving either a written request from a medical practitioner for a Pre-Program Psychological Assessment or an initial assessment report by a Provider, the Agent will advise whether: 
  • the request has been approved, 
  • the request has been denied, or 
  • if further information is required to make a decision. 
  • When further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information. 

What are the WorkSafe's invoice requirements? 

Refer to the How to Invoice WorkSafe guidelines. 

What fees are payable for the PTSD Group Treatment Program? 

  • Refer to the WorkSafe PTSD Group Treatment Program Fee Schedule 

In relation to a PTSD Group Treatment Program, what won't the Agent pay for? 

The Agent will not pay for: 

  • treatment or services for a person other than the worker (other than the delivery of a Partner and Family Support Module to a partner or first degree relative of the worker participating in the Group Treatment Program as this forms part of the worker's treatment) 
  • treatment or services provided by a health professional not registered and approved by the WorkSafe under Victorian workers' compensation legislation 
  • fees associated with cancellation or non attendance 
  • treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent 
  • meal expenses for a worker, their partner or family member 
  • the cost of treatment or services provided by telephone or other non face to face mediums such as telephone calls and consultations between providers and workers, and between other providers, including hospitals. 

Further Information 

Contact the referring Agent, email [email protected]

Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided.