Exercise physiologists' guide to WorkCover
This manual has been produced by WorkCover NSW to provide exercise physiologists and insurers with information about policies and procedures in relation to the provision of exercise physiology treatment for injured workers in NSW. This manual has been developed in consultation with the Australian Association for Exercise and Sports Science (AAESS) and aims to promote best practice in delivery of exercise services to injured workers in NSW.
WorkCover’s injury management system is designed to provide a framework which enables an early, safe and durable return of injured workers to the workplace. This is achieved in part through effective communication between the nominated treating doctor, insurer case managers, employers and other health professionals. Return to work should be the focus of any treatment provided.
Insurers require information from exercise physiologists to assist them in approving reasonably necessary treatment services, specifically:
- who is providing the exercise physiology treatment
- the treatment to be provided, and how this is coordinated with other injury management services to overcome identified barriers to return to work
- the quantity and cost of treatment to be provided, so that an accurate estimate of the total cost of the claim can be made (this is a WorkCover requirement for all claims)
- potential barriers to return to work and advice about functional ability and capacity to work
- identification of the outcome to be achieved and the relationship of this goal to the injured worker’s return to work.
Exercise physiologists prescribe functional exercise for the purpose of restoring an injured worker to suitable work activities. This should include specific exercise therapy related to the worker’s injury and work demands and/or specific work activities as exercise.
It is important to note that all exercise physiology services must be aimed at progressively increasing an injured worker ’s capacity to work and must have an end point. They should not be focused on improving a worker’s general level of health and fitness. In the case of aquatic exercise, progression to a land-based exercise program is a common step.
Reasonably necessary treatment
An insurer is only liable to pay for reasonably necessary treatment services related to the workplace injury. The factors underlying reasonably necessary treatment are:
- appropriateness of treatment
- availability of alternative treatments
- cost of treatment
- effectiveness (actual or potential) of treatment
- usage of treatment in similar cases (or acceptance)
To be appropriate, treatment must serve a purpose. It must have the capacity to:
- lessen the effects of injury
- sustain status quo
- retard progressive deterioration
The treatment provided must progress injured workers towards better health. If alternative avenues of treatment would substantially alleviate the problem, it would be difficult to regard the treatment in question as reasonably necessary.
There must be some cost-benefit analysis, particularly if alternative treatment exists. If treatment is provided at high cost but with minimal effectiveness, it may well be considered as not reasonably necessary where an effective alternative exists at a much lower cost.
How much the treatment can alleviate the consequences of injury will be considered when determining if it is reasonably necessary.
Whether or not a particular treatment approach has been used in similar cases, or is generally accepted by clinical peers, guides the decision about what is reasonably necessary treatment.
Outcomes based treatment
Australian Association for Exercise and Sports Science/WorkCover joint statement in relation to outcomes based treatment
All exercise physiology services should be based on best practice principles to ensure that the treatment provided is appropriate, and produces objective benefits. Outcome measures allow for monitoring the effectiveness of exercise physiology treatment, specifically in relation to the worker’s health, functional and return to work status. Best practice incorporates treatments for which there is research evidence of efficacy and that for which there is not yet evidence in the literature but which is based on scientific theory, clinical expertise and patient values (Sackett et al, 2000).
The goals of treatment must relate to sustained return to work at maximal possible function and enhanced self-management. This should be determined in consultation with the worker. The progress of treatment must be measured against these goals, in order to demonstrate the effectiveness of the treatment intervention. The provision of treatment where sustained objective improvement has not been demonstrated has the potential to reinforce dysfunctional illness behaviour, delay return to work, and add unnecessary claim costs.
Treatment outcomes should be expressed in functional terms as they relate to specific work task capacities. Examples of these are increasing tolerances for standing, walking, lifting, sitting, pushing, pulling and carrying. Treatment should primarily aim to:
- increase work status as identified within the injured worker’s medical certificate
- address improvements in activities of daily living
An estimate of outcomes of exercise physiology treatment involves comparison of measurements. The first measurement is taken when treatment commences, and others at later stages. Differences between initial and subsequent measurements demonstrate change that may be attributed to exercise physiology intervention. Other factors such as medications, psychosocial and other interventions must be taken into consideration when determining specific benefits derived from treatment.
When developing a treatment program, exercise physiologists should apply their assessment and exercise prescription skills and a sound reasoning approach to provide treatment that is reasonably necessary. This will be based on:
- appropriateness of the treatment for the workplace injury
- clearly identified goals of treatment designed to improve functional status
- clearly identified return to work goals to promote a return to pre injury work status
- clearly identified psychosocial barriers and treatment interventions designed to facilitate a sustained behavioural change
- the promotion of self management
- an understanding of the evidence supporting the efficacy of the treatment
- estimation of an approximate number of visits and timeframes required to achieve the stated goals
- measurable functional and psychosocial outcomes, so that treatment can be progressed, and ceased when treatment goals have been achieved or the treatment has resulted in no objective improvement
These procedures are effective from 1 January 2008 and apply to all open claims when exercise physiology treatment is being provided. This includes claims where exercise physiology commenced prior to this date.
WorkCover approval number Exercise physiologists who deliver treatment services to injured NSW workers must be approved by WorkCover and provide their WorkCover approval number on all accounts submitted to the insurer. This approval number is allocated to individual treatment providers and is transportable between practices if an individual treatment provider is to change employer.
Criteria for approval are:
- accreditation as an exercise physiologist with the Australian Association for Exercise and Sports Science (AAESS)
- professional indemnity and public liability insurance
- fit and proper person
- practice quality standards
Conditions of approval are:
- continued compliance with the criteria for approval and fulfillment of AAESS’ continuing education requirements
- completion of training specified by WorkCover within four months of notification of course availability
- notification to WorkCover of any changes to the information provided as part of the approval application.
To obtain an approval number complete the form available on the WorkCover web site and fax to 9287 4321. WorkCover will advise the approval number after processing. A list of approved exercise physiologists is available on the WorkCover website: www.workcover.nsw.gov.au.
To maintain your WorkCover approval number you must attend training within a specified period of being advised of availability of the training. Contact the training organisation, University of Wollongong Exercise Science and Rehabilitation Centre, to arrange to attend this training. If you have already been provided with an approval number but have not attended training within four months of notification by WorkCover of the training dates, your WorkCover approval number may be withdrawn.
All services delivered by you are invoiced using your WorkCover approval number, regardless of location. No other person, including an assistant, locum or student may deliver services using your WorkCover approval number.
Referral for exercise physiology services and request to conduct an initial assessment
The nominated treating doctor (NTD) is responsible for referring the injured worker for treatment services, including exercise physiology services. A health care practitioner, other than the NTD, or an accredited rehabilitation provider may recommend to the NTD or Insurer that EP services are appropriate. However, the NTD must approve the service and agree with this referral. This approval may be indicated on the medical certificate or as a separate written referral.
When you receive a referral to provide treatment for an injured worker you should ensure that no conflict of interest arises from any other role you may have in relation to that injured worker or another service provider involved in the management of that injured worker.
When an injured worker is referred to you, you should ensure that the NTD has approved the referral. You should contact the insurer to advise of the referral and to seek approval to conduct an initial assessment. Information to be included in your request includes:
- injured worker details (name, address, claim number)
- indication that the NTD agrees that the initial assessment should proceed
- your contact details
If you provide an assessment without seeking prior approval from the insurer you will not be paid for delivering the service.
The insurer will advise within 10 working days whether they agree that you should conduct an initial assessment. If the insurer does not respond to your request for approval within 10 working days, you may assume that the request is approved and proceed to conduct the initial assessment.
Once the insurer has agreed to the initial assessment, contact the injured worker and arrange a suitable time and location for the assessment.
Previous exercise physiology treatment from another exercise physiology provider
If the injured worker has previously been treated by another exercise physiologist based in the same practice, you should ensure you have access to the notes of that practitioner and continue to provide services agreed to under the approved Management Plan.
If an injured worker who has received exercise treatment from another service provider not based in the same practice, is referred to you, contact the original service provider to discuss the number of treatment sessions provided, treatment outcomes and identified barriers.
If approved, the insurer will pay the cost of an initial consultation by the new exercise physiologist (except when the new exercise physiologist is based in the same practice as the previous exercise physiologist). This fee is to cover the cost of liaison with the previous exercise physiologist, allow for an assessment and appropriate treatment and the preparation of a management plan if required.
It is the responsibility of the exercise physiologist to determine if the worker has received previous exercise physiology treatment (ie when and how many sessions), so that appropriate information may be provided to the insurer.
The Exercise Physiology Management Plan
The Exercise Physiology Management Plan assists the insurer to understand the timeframes and outcomes of treatment, and to ensure that treatment is reasonably necessary.
The Exercise Physiology Management Plan should be completed and submitted after the initial assessment. The plan is used to request up to eight treatment sessions. The insurer records the decision on the plan and returns it to you by fax or email. The insurer must approve of the treatment proposed in the submitted plan before any treatment can be provided. If you provide treatment without approval for the services under the plan, you will not be paid for the services.
If you plan to provide more than eight treatment sessions, you will need to complete a new Exercise Physiology Management Plan and submit it to the insurer for approval before you deliver any treatment beyond the initial eight sessions.Ideally, if more than eight treatments are proposed, the new plan should be submitted after the first five sessions. A new plan must also be submitted for every eight subsequent treatment sessions, unless prior arrangements have been made with the insurer.
After reviewing the plan, the insurer will:
- approve it and provide comment, if necessary, or
- request further information or clarification, or
- provide a reason for non-approval
Should the Exercise Physiology Management Plan contain insufficient information, the insurer will return it with an explanation of why further treatment cannot be approved. If further consultation fails to resolve the matter, the insurer may refer the matter to an independent consultant for an opinion. You may contact WorkCover on 1800 801 905 for further advice.
It is important to note that when an insurer approves a management plan, they are agreeing that the proposed treatment is reasonably necessary. This decision is based upon the information to hand at the time. If further information becomes available which persuades the insurer that the treatment is not reasonably necessary, these services will not be funded. For example, if liability for the claim is declined prior to the delivery of all the treatment sessions approved in a plan, treatments provided after the date of denial will not be paid for by the insurer. In the event that the insurer denies liability for services previously agreed to under the plan, the service provider will be advised by the insurer of this decision.
A copy of the Exercise Physiology Management Plan is at Appendix 2. The plan may be photocopied or printed. The plan may also be downloaded from WorkCover’s website located at www.workcover.nsw.gov.au under health care providers/exercise physiology. The purpose of the Exercise Physiology Management Plan is to provide justification based on for ongoing service delivery. The proposed treatment must have an outcome focus, and must clearly explain how treatment will assist the injured worker to return to work or to stay at work.
Instructions for completing each part of the Plan are at Appendix 3
Problems in relation to approval of Exercise Physiology Management Plans by an insurer that are unable to be resolved should be directed in writing to the Provider Services Branch, Locked Bag 2906, Lisarow, NSW, 2252 or by email to: email@example.com.
Services provided by a WorkCover approved exercise physiologist attract a maximum fee as set out in the Workers Compensation (Exercise Physiology Fees) Order 2015 made under the Workers Compensation Act 1987. There is no opportunity for WorkCover approved exercise physiologists to levy upon the insurer or injured worker a fee that exceeds the maximum fee set out in the Fees Order.
Exercise physiologists prescribe functional exercise for the purpose of restoring an injured worker to suitable work activities. This should include specific exercise therapy related to the injured worker’s injury and work demands and/or specific work activities.
Each service descriptor has its own payment classification code for the purposes of identifying the type of service delivered. The payment classification codes, service descriptors and fees payable are set out in the following table. All the fees described are ex-GST.
Additional program costs
- Necessary items must be included in the costs estimate for treatment as included on the Exercise Physiology Management Plan.
- An entry fee for a pool or gymnasium facility will only be paid where these services are provided at a facility off site from the exercise physiologist’s normal place of practice and an entry fee applies. An entry fee will not be paid by the insurer where the gymnasium or pool is owned or operated by the provider or the exercise physiologist provides contracted services to the facility.
- Reasonable expenses for equipment the injured worker takes with them for independent use at home (eg theraband) are payable at cost price.
- An additional fee will not be paid for exercise handouts or items used during the course of the treatment session.
- Payment for loan or hire of equipment may only occur where the cost of that new equipment exceeds $100 and must be agreed by the insurer prior to provision of that equipment.
Fees for cancellation or failure to attend
No fees are payable for cancellation or failure to attend scheduled treatments. Service providers are encouraged to implement scheduling systems which maximise attendance rates.
Pre-payment for planned services
Insurers do not pay in advance of services being provided, even where approval has been given to provide those services.
All invoices submitted by an Exercise Physiologist must be itemised and include the WorkCover approval number of the EP who provided the service.
The following information is to be included on the invoice:
- the words ‘Tax Invoice’ stated prominently
- the name of the practitioner who provided the service and practice details
- WorkCover NSW approval number
- the date the tax invoice was issued
- the provider’s Australian Business Number (ABN)
- the injured worker’s name and claim number
- date of each service
- appropriate WorkCover NSW payment classification code
- service cost for each WorkCover NSW classification code
- a brief description of each service item provided, including areas treated
- payee details
Commutations and common law settlements
Commutation and common law settlements for workers compensation claimants remove ongoing liability for treatment expenses from the effective date of the commutation or common law settlement. This means that the insurer will not pay for any services delivered after the effective date of the settlement. It is advisable that if you are treating an injured worker who is in the process of seeking a commutation or common law settlement you should ensure that they advise you of the effective date as soon as possible.
WorkCover NSW has appointed a network of independent consultants who provide an independent opinion regarding allied health service delivery on a case by case basis, at the request of the insurer. Referral by an insurer to an independent consultant is intended to achieve the following objectives:
- review of service delivery by expert service providers with clinical experience in the management of work-related injuries
- education and advice for insurers and service providers on a case by case basis regarding how to achieve good treatment outcomes
- negotiation with the treating exercise physiologist to determine the best outcome for the injured worker
- control of costs by recommending the cessation of service delivery that is not reasonably necessary, or by providing recommendations for appropriate treatment
- to assist agents and employers to better understand when and how much exercise physiology is reasonably necessary
All independent consultants are required to meet certain conditions of appointment which are set out in Appendix 4. The list of consultants is available on the WorkCover website.
The services provided by an independent consultant will be paid for by the insurer and will be charged as a cost to the claim.
An integral component of the review process is consultation with the treating exercise physiologist. You may be contacted by an independent consultant to discuss your current and proposed treatment for an injured worker.
When the insurer might consider using an independent consultant
The insurer will consider referring an injured worker’s claim to an independent consultant if, after discussion with the treating exercise physiologist, the insurer is concerned about:
- the number of treatments proposed, or
- the frequency of proposed treatment, or
- the reasonable necessity of treatment, or
- the ongoing need for treatment
The process of review by an independent consultant
The flow chart at Appendix 4 explains the process of review by an independent consultant.
The insurer selects an independent consultant from the list and forwards a referral to the independent consultant, including any relevant exercise physiology treatment and medical documentation. Following review of these reports, the independent consultant may contact the treating exercise physiologist to discuss treatment. If there is agreement that ongoing treatment is to continue for a specified period or is to cease, the independent consultant will inform the insurer and the treating exercise physiologist of this in writing.
If the independent consultant and the treating exercise physiologist cannot agree that the proposed treatment is reasonably necessary, the insurer will arrange for the independent consultant to assess the worker. On completion of this assessment, the independent consultant will provide a report to the insurer and to the treating exercise physiologist with recommendations regarding future treatment requirements.
Complaints about independent consultants
Complaints in relation to the conduct of an independent consultant that are unable to be resolved should be referred in writing to the Manager, Allied Health Providers WorkCover NSW, Locked Bag 2906, Lisarow, NSW 2252 or by email to: firstname.lastname@example.org.
Complaints about discontinuation of Exercise Physiology services
Following review by an independent consultant, if the worker is not happy with the decision by the insurer to discontinue treatment, the worker may request the insurer to undertake a review of their decision and may provide any additional information to assist them in doing so.
If the complaint persists after internal review of the insurer’s decision, the worker may refer the matter to the WorkCover Claims Assistance Service (CAS). This service will liaise with all parties in order to effectively resolve the complaint.
If the complaint is unable to be resolved by CAS, the matter may be referred to the Workers Compensation Commission (www.wcc.nsw.gov.au). Arbitrators within the Commission will review the evidence and determine whether treatment should continue or should discontinue. An approved medical specialist may be asked to review the worker to assist in the decision.
Other parties in the workers compensation system
The Workplace Injury Management and Workers Compensation Act 1998 identifies specific responsibilities for insurers, employers and medical practitioners designed to encourage the safe, timely and durable return of injured workers to the workplace.
The injured worker
When there is an injury at work, the injured worker must:
- seek medical attention
- notify the employer as soon as possible
- record their name, the date and cause of the injury in the employer’s Register of Injuries
- sign the WorkCover medical certificate, if one is required
- participate and cooperate with the development and implementation of an injury management plan
- comply with requests made by the insurance company with regard to their claim
- make all efforts to return to work as soon as possible
An injured worker is entitled to choose their treatment provider. If the treatment delivered by that service provider is not effective in achieving suitable outcomes the insurer may request that the injured worker choose another service provider.
Employers in NSW are responsible for providing a safe and healthy workplace. Every employer must purchase a workers compensation insurance policy covering all employees. They must also establish a workplace return to work program which is consistent with the insurer’s injury management program.
When an injury occurs, an employer must contact their insurer within 48 hours of any injury that is likely to result in a worker being off work for more than 7 days. All other injuries must be notified to the insurance company within 7 days.
Employers must forward any completed claim forms to their insurer within seven days. They must also implement and monitor a return to work plan for the injured worker.
In NSW, seven organisations operate as Scheme Agents in the NSW WorkCover Scheme and deliver claims and policy services under commercial contracts. Their contact details are
listed in Appendix 5
Some organisations are licensed by WorkCover to be self-insurers, specialised insurers and group self-insurers.
An employer with a self-insurer's license carries its own underwriting risk and control its own claims administration. There are strict criteria that employers must meet before WorkCover will approve a self-insurer's license. Specialised insurers have a restricted license to underwrite workers compensation risks specific to a particular industry or class of business or employer.
After being advised by the employer that a worker has suffered a significant injury, the insurer must:
- commence provisional liability payments of weekly benefits and medical expenses within 7 days, unless a reasonable excuse exists,
- contact the worker, the employer, and the treating doctor (if required) within three days, and consult with all relevant parties to ensure that the worker receives necessary assistance to recover and return to work
- develop an injury management plan for the worker in consultation with the employer, the doctor and the worker
- provide the employer and worker with information regarding the injury management plan
- keep the employer informed of significant steps taken or proposed under the injury management plan
Return to work coordinator
A return to work coordinator is a worker nominated by the employer or a contractor specifically engaged for the role, and whose principal purpose is to assist injured workers to return to work in a safe and durable manner. The return to work coordinator ensures that the employer’s return to work policy and procedures are implemented.
The role of the RTW coordinator is to:
- assist employers to develop and implement their return to work programs
- assist injured workers to return to work as soon as medically appropriate
- develop and evaluate return to work plans, documenting suitable duties and work restrictions
- initiate and maintain contact with the workers, their supervisors, the nominated treating doctors and other relevant parties (including treating practitioners)
- ensure that injured workers in need of specialized rehabilitation services are referred to appropriate rehabilitation providers
- coordinate and monitor the progress of injured workers
Large businesses must designate a return to work coordinator who must attend WorkCover approved training. In small business it is often the employer who undertakes the role of return to work coordinator.
Nominated treating doctor (NTD)
A worker who will be off work for more than seven days must nominate a treating doctor who will be responsible for coordinating all aspects of treatment and return to work management. The information provided on the WorkCover medical certificate assists the insurer to develop individual injury management plans.
Nominated treating doctors liaise with return to work coordinators at the workplace to develop and upgrade return to work plans. Nominated treating doctors may also seek advice from accredited rehabilitation providers, to ensure that identified duties are safe for an injured worker.
Other service providers
Accredited rehabilitation provider
An accredited rehabilitation provider may be engaged in more complex cases for a range of reasons, including:
difficulty in finding suitable duties
problems between the injured worker and the employer
other specific barriers to return to work.
Rehabilitation providers are organisations staffed by health professionals such as occupational therapists, exercise physiologists, rehabilitation counselors and occupational psychologists, who specialise in occupational rehabilitation. They must be accredited by WorkCover NSW in order to deliver rehabilitation services to injured workers. Currently there are about 260 accredited rehabilitation providers in New South Wales.
The services available from an accredited rehabilitation provider include:
- initial rehabilitation assessment
- functional assessment
- workplace assessment
- job analysis
- advice concerning job modification
- rehabilitation counseling
- vocational assessment and counseling
- advice or assistance concerning job seeking
- advice or assistance with vocational re-education or training
- work conditioning
- functional education
Additional services include:
- identification of suitable duties
- monitoring of return to work on suitable duties
- identification and placement in suitable employment
Providers may contact exercise physiologists for specific information regarding functional ability and work capacity.
Queries or complaints about accredited rehabilitation providers in NSW can be directed to WorkCover’s Provider Services Group on 1800 801 905 or by email to email@example.com.
Injury management consultants
When there is a disagreement over the suitability of selected duties offered by an employer, the insurer or the employer may engage the services of an Injury Management Consultant. These consultants are medical practitioners approved by WorkCover specifically for the purpose of reviewing a worker’s fitness for employment and the availability of duties at a workplace.
Injury management consultants may also assist the Workers Compensation Commission in resolving injury management disputes.
WorkCover’s Claims Assistance Service
This service assists with managing complaints and disagreements between workers and insurers.
The Workers Compensation Commission
The Workers Compensation Commission deals with all disputes that arise out of workers compensation claims unless these disputes are already before the Compensation Court. The Commission has three main roles:
- expedited assessments so disputes about benefits and payments can be quickly resolved
- resolution of medical disputes
- conciliation/arbitration of disputes about suitable duties
The Commission is structured to provide a speedy and flexible dispute resolution system. Disputes will be referred promptly to the appropriate part of the Commission for assessment and
Approved medical specialists
Approved medical specialists are appointed by the Commission to decide questions about causation, prognosis and treatment, level of impairment, suitability of employment and fitness for work. Their decisions in relation to permanent impairment are binding. Their opinion in the other non-binding matters will be used by the arbitrators in the Commission to help resolve the dispute.
Where to go for assistance
WorkCover Information Centre/Claims Assistance Service
For all enquiries relating to injury management, workers compensation and occupational health and safety.
Phone: 13 10 50
WorkCover Publication Order Line (for all publications)
Phone: 1800 799 003
Information about WorkCover accredited rehabilitation providers and training and employment programs
Phone: 1800 801 905
Workers Compensation Commission
Phone: 1300 368 040
Australian Association for Exercise and Sports Science
Phone: 07 3856 5622
Appendix 1 - Flow chart of procedures
Appendix 2 - Exercise Physiology Management Plan
Appendix 3 - Exercise Physiology Management Plan explanatory notes
This Exercise Physiology Management Plan must be used to request approval to deliver exercise physiology treatment services. This applies to all services provided by exercise physiologists for injured workers in the NSW Workers Compensation Scheme.
If you begin treatment without the approval of the insurer, you may not be paid for delivering the service.
A separate fee is not payable for preparation and submission of the plan, as it is completed during a treatment session and developed in consultation with the worker.
All sections of the plan must be completed – failure to do so will delay processing and approval. The WorkCover approval number of the accredited exercise physiologist must be provided.
Complete the plan after the initial assessment and submit it to the insurer for approval before you deliver any treatment. If it is anticipated that more than eight treatments will be required, and to ensure continuity of service, a new plan should be submitted after the first five sessions. A new plan must also be submitted for every eight subsequent treatment sessions, unless prior arrangements have been made with the insurer.
The exercise physiologist completing and signing the plan is responsible for its content. Once complete, email or fax the plan to the insurer.
Plan identification details
- Indicate the worker’s name, date of birth and claim number at the top of the Plan. Failure to do so will delay processing. Ask the worker for details.
- To understand the worker’s capacity to return to safe durable work, familiarise yourself with the worker’s occupation.
- Include the date of injury. Ask the worker or insurer case manager for details.
- Provide the diagnosis as indicated on the medical certificate and referring only to the compensable workplace injury. Do not list signs and symptoms.
- Indicate the name of the insurer and the name of the insurer’s case manager and their contact details.
- Include the name of the person who referred the worker for treatment and their phone details.
- Include your details, including practice name and address, phone and fax numbers, and email address . If more than one exercise physiologist in your practice is treating the worker, the details pertaining to the exercise physiologist who most frequently provides the treatment should be listed here.
- Include your WorkCover Provider Number.
- Indicate the Plan Number for this plan. eg Plan number 1 is the plan for treatments 1 to 8 inclusive, Plan number 2 is the plan for treatments 9 to 16 inclusive. If the worker requires further treatment, e new plan must be numbered consecutively, even if there is a significant gap between treatment episodes.
- Indicate the number of consultations required for this plan and the types of services to be delivered, by category of service – standard, reduced supervision and group service, to a maximum total of 8.
- Indicate the date you conducted the initial assessment, and the projected date of commencement if approved. Also include the estimated date of completion of treatment under this plan, if approved.
- Sign and date the Plan and when approval is obtained, note the date of advice from the insurer
An outcome measure is designed to demonstrate the effectiveness of a treatment intervention with specific regard to the injured workers return to health and return to work.
They guide reasoning in relation to treatment and assist in evaluating the worker’s progress.
The outcome measures identified will assist the insurer to determine the reasonable necessity of proposed management.
The exercise physiologist must identify two relevant outcome measures in consultation with the worker:
- work status
- functional restrictions limiting return to work
The outcome measures need to be reported at:
- initial assessment
- current measure – at the date of development of this plan (if this is Plan number 1 delete or cross out this column)
- anticipated outcome – what will be achieved at the conclusion of this plan
Indicate the work status using the following descriptors:
- not working
- suitable duties – reduced hours
- suitable duties – full pre-injury hours
- pre-injury duties – reduced hours
- pre-injury duties – full pre-injury hours
Clearly indicate the functional restriction/s limiting return to work and specify the level at initial assessment, the worker’s current capacity to perform the task and what you expect to achieve as a result of the intended management. The functional restriction must relate to a work task. Examples of functional restrictions:
- overhead tasks
If unclear about tasks or functional demands, contact the employer or rehabilitation provider to request a copy of their workplace assessment report to assist with the formulation of appropriate goals and measures.
Ensure that the functional measures used are relevant to the injured worker’s job.
Indicate the item description and costs for additional items such as travel, case conference, equipment and reports requested by the insurer. The insurer will not pay for additional items not included on the plan and approved prior to provision.
Describe the types of exercise treatment modalities that are to be delivered.
Identify barriers to Return to Work. For example, barriers may include the worker’s fear of reinjury, lack of available suitable duties at the workplace, or the continued certification of a worker as totally unfit despite measurable progress in the worker’s physical capacity.
The barriers identified may not have immediate solutions and your recommended strategies may not necessarily relate to exercise physiology intervention. For example:
- 'fear of re-injury’ may be addressed by recommending referral to a rehabilitation provider to ensure the duties are safe
- the insurer referring the worker to an Injury Management Consultant may address ‘medical restrictions continuing despite measurable progress’.
If there are no return to work barriers use ‘nil identified’ or ‘not applicable’.
Use section 6 to indicate the need for additional assistance – for example, from a rehabilitation provider, injury management consultant, independent consultant or an independent medical examiner. NTD and worker agreement. The worker must agree to the Exercise Physiology Management Plan. In addition, there must
be evidence on the Plan that the nominated treating doctor has had reasonable opportunity to contribute to and comment on the Plan.
Appendix 4 - Independent consultant flow chat
Appendix 5 - WorkCover Insurance agents
Allianz Australia Workers' Compensation (NSW) Limited
Phone: 1300 130 664
Plans submitted to firstname.lastname@example.org
CGU Workers Compensation (NSW) Limited
Phone: 02 9088 9000
Plans submitted to email@example.com
Employers Mutual NSW Limited
Phone: 1800 469 931
Fax: 02 8251 9000
Plans submitted to firstname.lastname@example.org
GIO General Limited
Phone: 13 10 10
Plans submitted to email@example.com
QBE Workers Compensation (NSW) Limited
Phone: 1800 112 472
Fax: 02 9375 4444
Plans submitted to Elizabeth.Worcester@qbe.com