Independent consultants are approved by WorkCover to provide independent peer review of treatment. An integral component of this review is consultation with the treating practitioner. There are two groups of independent consultants: those that review physical treatment and those that review psychological treatment.
An independent consultant for the review of physical treatment provision is a registered physiotherapist, chiropractor or osteopath experienced in the assessment, treatment and management of workplace injuries. An independent consultant for the review of psychological treatment is a registered psychologist or clinical member of the Counsellors and Psychotherapists Association of NSW experienced in the assessment, treatment and management of psychological workplace injuries. These independent consultants are appointed by a selection panel that comprises representatives from WorkCover, the relevant professional associations and the Australian Health Practitioners Regulation Agency.
The role of an independent consultant is to:
- determine whether further treatment is considered reasonably necessary
- work with the treating therapist to reach agreement on future treatment content and duration that will achieve the best outcomes for the injured worker
- advise the treating therapist, the insurer, and injured worker on the ongoing need for further treatment
- control costs by recommending the cessation of service delivery that is not reasonably necessary, or provide recommendations for more appropriate treatment.
Injured workers may be referred to an independent consultant when the insurer is concerned about the:
- type and/or number of treatments provided and/or proposed
- failure of the injured worker to make functional improvements and/or return to work despite ongoing treatment.
The treatment provider may also request the insurer make a referral to an independent consultant to assist them in determining future appropriate treatment/management of the injured worker.
A review by an independent consultant involves the:
- insurer selecting the independent consultant from the list of WorkCover-appointed independent consultants
- insurer's case manager having a conversation with the independent consultant about the need for referral and ensure the independent consultant has information about the broader context of the claim
- insurer's case manager formalising the request for review by sending a referral, and any relevant treatment and medical documentation directly to the independent consultant (not via a medico-legal organisation)
- independent consultant contacting the therapist to discuss treatment.
If the treating therapist and independent consultant agree that ongoing treatment is to continue for a specified period or is to cease, the independent consultant informs the insurer and the therapist of the reasons in writing.
If the treating therapist and independent consultant do not agree that the proposed treatment is reasonably necessary, the insurer arranges for the independent consultant to assess the injured worker. On completing the assessment, the independent consultant discusses the findings with the treating therapist and provides a report about future treatment requirements to the insurer and treating therapist. The treating therapist then notifies the nominated treating doctor of any changes to the injured worker’s treatment program.
If, following a review by an independent consultant, an injured worker is not satisfied with the insurer’s decision regarding treatment, they may refer the matter to the Workers Compensation Commission. Arbitrators will review the available evidence and determine whether the treatment is reasonably necessary. In some cases, an approved medical specialist may be asked to review the injured worker to assist in the decision.
Independent consultants have the cost of their services paid by the insurer as a claims cost.
Fees for cancellation or non-attendance apply. See Fees Order.
Call 13 10 50 for more information about indepedent consultants.