WorkCover and Compulsory Third Party (CTP) Insurance Claims

WorkCover and Compulsory Third Party (CTP) Insurance Claims

WorkCover

WorkCover and Physio Gym™ Physiotherapy
Physio Gym™ Physiotherapy is the perfect environment for rehabilitation following work injuries and road accidents. All of our physiotherapists are WorkCover approved practitioners. Our physiotherapists are experienced and skilled in the treatment of all types of injuries. We also have state of the art exercise equipment which will expedite your recovery and get you back to work as soon as possible. Our staff will smoothly guide you through what can appear to be a complicated process.
There were over 30, 000 workplace injuries reported during 2008/09 with males compromising 66% of all workplace injuries (WorkCover NSW, 2008). Injuries commonly treated by your physiotherapist include low back pain, neck pain, shoulder pain, knee pain, and hand injuries. These injuries may be a result of a sudden incident such as a fall or lifting a heavy object. However, many injuries are a result of incorrect posture and repetitive actions such as computer work.

What do I do if I have been injured at work?

At face value WorkCover can appear to be a very complicated process and a little overwhelming so here are a few simple steps that will make it easier for you.
1. Notify your employer that you have been injured at work as soon as possible. The employer must alert the insurer of the injury within 48 hours of the injury being notified.
2. Go to your doctor and they will fill out a WorkCover medical certificate. This doctor will now be your Nominated Treating Doctor (NTD) and they will also refer you to a physiotherapist
3. Give a copy of your WorkCover medical certificate to your employer and insurer
4. Call Physio Gym™ Physiotherapy (02 9569 5899) and make an appointment
5. Take you WorkCover medical certificate and any other insurance information (eg letter of acceptance of liability from the insurer) with you to your initial appointment with the Physiotherapist or Exercise Physiologist.
6. Return to your doctor for a review and to have your WorkCover medical certificate updated
7. Always bring a copy of any new WorkCover medical certificate to your physiotherapist
8. If you require more than 8 Physiotherapist sessions the physiotherapist will require to do a Work Cover Management plan. This must be conducted during consultation time.
9. Under new Work Cover Legislation treatment is limited to one year for complicated injuries. Some cases can be extended if surgery is involved.
10. For more information visit http://www.workcover.nsw.gov.au/injuriesclaims/Pages/default.aspx

Do I have to pay?

No, we will bill the insurer if all of the following exists:
A. You have a current WorkCover medical certificate requesting Physiotherapy or Exercise Physiology treatment,
B. A WorkCover claim number,
C. A letter of acceptance of liability from your insurer.
D. You have current Physiotherapy plans approved. **
** Please note initial a Physiotherapy Plan is not required for the first 8 sessions, after which it is mandatory.
Yes you will have to pay in the following conditions:
a) Your claim has not been accepted by the insurer and is pending. The insurer will reimburse you once the claim has been accepted.
b) You do not attend a schedule session and provide 24 hour notice of cancellation. In this case you will be held liable to cover the cancellation fee at your expense. You cannot seek compensation for missed sessions from your insurer.
c) If you are currently receiving physiotherapy, exercise physiology, chiropractic or osteopathy of another clinician for the same WorkCover case. You cannot see different clinicians from different practices or business. If you do not make us aware of this scenario and we claim on your behalf you will be held liable to pay the amount owing.

Tracking your visits

A new WorkCover plan is required every 8 sessions for payments of treatments to be processed. We deliver the first plan at session 6 to ensure the insurer will have time to respond and approve ongoing therapy. Therefore the next plan will be submitted in session fourteen.
To help manage this we are required to track your visits. At Physio Gym™ Physiotherapy we track your visits by issuing you a members’ card. You must swipe this card each time you visit. This allows us to record your attendance and accurately track visits so we can deliver WorkCover plans in a timely fashion to the insurer for approval.

Extra Information

At the onset of your treatment you may be requested to complete questionnaires to determine the severity of your condition. This information is then sent to WorkCover to help develop a strategy to best manage duration of predicted treatment, e.g. 1month, 3 months or up to a year. It also allows the therapist to determine if there could be barriers to you healing at the expected rate.

The Questionnaires delivered will be appropriate to your condition and may measure the following:
1) How your injury affects you
2) Your pain
3) Your pain and work
4) Your back pain
5) Your neck pain and function
6) Your injury affecting depression, anxiety and stress

You may also be asked to conduct a functional physical assessment to determine you readiness to return to work. This may include
1) Walking test
2) Lifting test
3) Grip test
4) Sitting tests
5) Balance challenges
6) Torso strength test
7) Tests relevant to your work conditions and injury.

Who is involved in a WorkCover claim?

The vast majority of WorkCover cases involve just the doctor, insurer and physiotherapist. In some cases other parties will also be involved in assisting your recovery.
• Insurer – every employer in NSW is required to have a workers compensation policy or be licensed by WorkCover to be self-insured. Your insurer will assign you a case manager who will be in charge of your claim.
• Nominated treating doctor (NTD) – will be responsible for coordinating all aspects of treatment and return to work management. Treating physiotherapists often liase with the NTD and provide information about the worker’s functional abilities and restrictions.
• Physiotherapist or Exercise Physiologist (AKA Treatment Provider)
• Rehabilitation provider – these are WorkCover approved health professionals experienced in workplace rehabilitation. They liase with the workplace, NTD and treatment provider to implement and monitor return to work practises.
• Return to work coordinator – is an individual appointed by the employer, who has responsibility for the practical implementation of the company’s return to work policy and procedures, with the principal purpose being to assist injured workers to return to work in a safe and durable manner.
• Injury management consultant (IMC) – a registered medical practitioner who assists in the return to work process when differences arise between a nominated treating doctor, the employer and/or the insurer. These consultants are approved by WorkCover specifically for the purpose of reviewing a worker’s fitness for employment and the availability of duties at a workplace.
• Independent Medical Examiner (IME) – specialist medical practitioners with qualifications relevant to the worker’s injury who provide impartial medical assessments of an injured worker.
• Other treatment providers include psychologist, occupational therapist, medical specialist etc.

Communication is the key to helping us help you.

You must provide Physio Gym™ Physiotherapy with:
a) The contact details of all key therapists and stakeholders in your claim.
b) Details of future appointments e.g. going to specialists or nominated treating doctor for medical certificate updates.
c) Accurate information.
It is optional if you would like to provide access to your E-health record.

At times we required to send information such as WorkCover plans, letters of progress and assessments to all key therapist and stakeholders.
Information may be delivered through:
• Conventional mail
• Fax
• Encrypted emails (E-referrals)
• E-mail
• Uploading information to your E-Health records

Compulsory Third Party (CTP) Insurance Claims

CTP and Physio Gym™ Physiotherapy
The above information and conditions outlined above for WorkCover also applies to CTP claims. The main differences are:
A Notice of Commencement (NOC) form must be completed Instead of a WorkCover Plan at the very start of treatment.
A Review form must be completed after the set services agreed upon by the insurer and the therapist is completed.
There is a set budget of treatment.
If the treatment requires more than the expected budget and the injury is deemed complicated then an application for further treatments is required. Physiotherapy can not be applied during this period of application until it is approved.