Role of and referral to an independent consultant
The role of the independent consultant
An independent consultant provides peer review and independent opinion regarding allied health treatment and management of individual cases.
Independent consultants may:
- determine whether further treatment is reasonably necessary
- work with the treating practitioner to decide future treatment content duration that will achieve the best outcomes for the worker and increase the worker’s capacity for employment
- advise the treating practitioner, insurer and worker on the ongoing need for further treatment
- educate allied health practitioners about the NSW workers compensation system
- complete a biopsychosocial assessment of a worker with consideration given to their diagnosis and prognosis.
The independent consultant does not:
- determine causation or liability
- undertake a functional capacity evaluation or any formal assessment of work capacity for the purposes of assessing work capacity.
Who can be an independent consultant?
An independent consultant:
- is an allied health practitioner registered with the Australian Health Practitioner Regulation Agency (AHPRA)
- is a physiotherapist, chiropractor or osteopath for the review of physical treatment,
- is a psychologist for the review of psychological treatment
- is experienced in delivering health services within the NSW workers compensation system
- has satisfied defined selection criteria and agreed to conditions of approval
- is approved by SIRA for a three year term (with an option by SIRA to extend up to a maximum five years) as an independent consultant, and
- is listed as an approved independent consultant at www.sira.nsw.gov.au.
Referral to an independent consultant
A referral for an independent consultant review should occur early in the recovery process in order to achieve the best outcome for the worker.
Any member of the support team may recommend a referral to an independent consultant. The insurer will approve the referral and complete the referral form with the information provided from any third party. Please use the SIRA independent consultant referral form.
The independent consultant should be (where possible) of the same discipline as the allied health practitioner managing the worker.
A referral may be initiated in the following ways:
At the request of the insurer
The insurer should consider a referral to an independent consultant where an allied health practitioner requests treatment continue beyond 16 sessions, or if, after discussion with the treating allied health practitioner, there is concern about:
- the treatment duration, frequency and/or whether treatment is reasonably necessary
- treatment that has continued for an extended period without any improvement in functional outcomes, particularly in relation to a worker’s capacity
- the treatment approach most likely to achieve positive work outcomes for the worker
- barriers to recovery at work and/or psychosocial risk factors for delayed recovery and work loss.
The insurer should confirm the appropriateness of the referral to an independent consultant, using their own internal resources (eg injury management advisor, team leader) and also ensure there is no conflict of interest between the independent consultant and allied health practitioner.
At the request of the allied health practitioner
The allied health practitioner is encouraged to request the involvement of an independent consultant where barriers to recovery, progress, return to work or active participation are evident and you consider an independent opinion and/or expert advice is likely to be beneficial in the management of the worker’s injury.
SIRA supports the proactive involvement of an independent consultant in these cases in order to achieve the best outcome for the worker.
Contact the insurer by telephone or note your request and rationale in the space provided on the Allied health recovery request. You can fill out the interactive version of the AHRR or download the static version.
At the request of another member of the support team
Other members of the support team, such as the employer, the doctor, the workplace rehabilitation provider or the worker, can request an independent consultant review if recovery progress has been delayed, or if guidance regarding treatment management options is required.
Approving and arranging the independent consultant referral
Before they approve a referral to an independent consultant, the insurer will make direct contact with the allied health practitioner in order to discuss worker treatment, its progress and the referral. Any referral to an independent consultant is to be arranged by the insurer not a third party such as a medico-legal company.
Once the referral is approved the insurer is required to:
- select a SIRA approved independent consultant from those listed on the website (from the same discipline as the treating allied health practitioner if possible)
- complete the referral form, attach all relevant information and email it to the independent consultant
- approve the stage of review (1, 2 or 3) after discussion with the independent consultant
- inform the treating allied health practitioner, worker and the doctor of the referral and its purpose.
It is recommended the insurer consider approval for a limited number of treatment sessions while the referral and review are being undertaken, as halting treatment may lead to additional barriers to progress.
Independent consultant reviews
An independent consultant review may take three different forms:
Stage 1 - file review
This involves a review of the allied health recovery request(s) and/or other relevant documentation, to assist an insurer to determine reasonably necessary treatment services or equipment prescription. This is only to occur where the specialised skills of an independent consultant are required. The independent consultant is not to replace the role of the insurer’s injury management advisor.
Stage 2 - file review and discussion with treating allied health practitioner
This involves the consideration of all allied health recovery request(s) and other relevant documentation, as well as discussion with the treating allied health practitioner. The discussion with the treating practitioner is likely to include current treatment outcomes, proposed treatment and intervention to build the worker’s capacity for employment.
Stage 3 - assessment of worker and discussion with treating allied health practitioner
If after the review of the referral information, the independent consultant determines an assessment of the worker is required for an effective review, they will ask the insurer to advise the worker of what is involved and arrange an appointment.
Discussion with the treating practitioner is likely to include current treatment outcomes, proposed future treatment and intervention to build the worker’s capacity for employment.
Participation of allied health practitioners
In stage 2 and 3 reviews, discussion with the treating allied health practitioner is an important part of the independent consultant review process.
Treating practitioners must participate in discussions with the independent consultant, unless extenuating circumstances prevent them from doing so (eg hearing impairment). In this situation, alternative communication means are to be used.
Discussions should be arranged within business hours unless another time is mutually agreed. Responses to contact made by an independent consultant should be provided by the allied health practitioner within three working days, unless reasonable circumstances prevent contact within this timeframe.
Report of an independent consultant review
Once the review is complete, the independent consultant will provide a report with recommendations to the treating allied health practitioner, insurer and nominated treating doctor.
The independent consultant should provide their report within 10 working days of their review, unless prior arrangements regarding a different timeframe have been made with the insurer.
The insurer’s decision about funding of future treatment will take into account the recommendations of the independent consultant, as well as other information available at the time. Independent consultant recommendations are not binding, but influential in guiding decisions about future treatment.
The insurer is responsible for implementing and monitoring the independent consultant recommendations in a timely manner.
Payment for independent consultant reviews
Services provided by an independent consultant are paid for by the insurer and are charged as a cost to the claim. The Workplace Injury Management and Workers Compensation (Independent Consultant) Fees Order applies: www.sira.nsw.gov.au.
No fee is payable to the treating allied health practitioner for the time spent liaising with the independent consultant.
Complaints about independent consultants
Complaints should be referred to the insurer in the first instance, and if you are not satisfied with the outcome contact the SIRA Customer Service Centre on 13 10 50.