CTP for compers

Question 1

CTP (Compulsory Third Party) Insurance

Answer 1

eg road traffic crash
• FAULT-based scheme – at fault driver is NOT covered by CTP insurance scheme.
• CTP Insurer pays for private hospital, medical and pharmaceutical expenses reasonably and appropriately incurred because of the injury.
• No wages paid in CTP cases and employer not required to keep job open.
• Goal is return to pre-injury function as not all claimants are workers (e.g. children, students, retired people).
• Medical certificate required for physio payments.
GOAL IS TO RETURN TO PREVIOUS FUNCTION

Question 2

Workplace Compensation and Rehabilitation Legislation

Answer 2

• Compulsory in Australia
• All operate as a NO FAULT system (i.e. you receive compensation whether you caused the injury or not)
• Protects both the worker and their employer in the event of a work-related injury or disease.
• Funded by premiums employers pay based on industry, no. of employees and claims history.
• In QLD “WorkCover”
• Every worker, volunteers, work experience students are covered.
• “includes travel between home and place of employment!

Question 3

QLD WC Insurers pay:

Answer 3

o Income replacement while worker recovers.
o Medical treatment, medication, surgery, travel for appointments, rehabilitation, appliances (e.g. prostheses, aids).
o Death benefits – including special provisions for children and funeral costs.
o Lump sum for permanent impairment – calculated by a “table of injuries”

Question 4

• Income replacement:

Answer 4

o First 26wks: Greater of 85% NWE or Award
o 26wks – 2yrs: Greater of 75% NWE or 70% QOTE
o 2-5yrs: Greater of 75% NWE, 70% QOTE or amount equal to single pension rate (if injury resulting in WRI >20%).

NWE = Normal Weekly Earnings; QOTE = Queensland full time adult persons Ordinary Time Earnings; WRI = Work Related Impairment

Question 5

• WC starts when worker assessed by:

Answer 5

o Medical practitioner;
o Dentist;
o Nurse practitioner.

Question 6

WC ends when:

Answer 6

o No more medical certificate
o worker has RTW or is recovered
o medical tribunal says so
o progress has plateaued – then assessed for Permanent impairment
o worker not complying (e.g. not turning up for appointments)
o After 5 years but most settle within 2yrs
o QLD has a ‘short tail’ scheme (i.e. claims settled within 2 years)

Question 7

Damages – Common Law Claim:

Answer 7

• If the worker feels their employer was negligent and to blame for the injury, they may sue their employer for damages.
• The onus of proof of negligence is on the worker.
• Damages claims are determined by a court.

Question 8

Employer:

Answer 8

• Keep job open for 12mths (i.e. cannot dismiss a worker solely because of the injury).
• Keep regular contact with worker and Insurer customer advisor.
• Identify and provide duties of suitable standard + monitor the worker’s progress.
• Provide a supportive environment – be understanding of co-workers.
• If the employer considers it is impractical to provide the worker with suitable duties, must give WorkCover QLD evidence of this.

Question 9

Role of Physio **

Answer 9

– Deliver Treatment According to Clinical Framework:
• Outcome-focused and goal-orientated services achieve maximum function and safe RTW.
• Consider biopsychosocial factors
• Advise and liaise with the relevant treating practitioners and insurer.
• Keep detailed, appropriate, up-to-date treatment records and relevant information obtained in the service delivery.
• If >5 Treatment Sessions required… Insurer may require the Provider Management Plan to be provided.