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PHTY3280 > L13: RTW after injury and illness > Flashcards

L13: RTW after injury and illness Flashcards

1
Q

What does CTP stand for?

A

Compulsory Third Party

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2
Q

What does RTW stand for?

A

Return to Work

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3
Q

What does WC stand for?

A

workers compensation

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4
Q

After working in your dream job as a physiotherapist for 6 months, you are involved in a motor vehicle accident on the way to work. Your injuries are considered non-life threatening (eg whiplash, fractured clavicle) but you need to take time out from work.

  • How will you cover your living and rehabilitation expenses if you are not working?
  • Are your rehabilitation expenses covered by your employer, your private health insurer, the Compulsory Third Party Insurer or Workers Compensation Insurer?
  • What would happen if this problem becomes chronic and you cannot work for an extended period?
A

XXX

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5
Q

What are 5 benefits of work?

A
  1. A social determinant of health
  2. Enables people to be productive and contribute
  3. Provides income: material well-being and participation in today’s society
  4. Meets important psychosocial needs in societies where employment is the norm
  5. Employment and socio-economic status are the main drivers of social gradients in health

it needs to be ‘good work’

Satisfaction, purpose, financial benefit, productivity

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6
Q

What is the definition of good work?

A

“Good work is engaging, fair, respectful and balances job demands, autonomy and job security. Good work accepts the importance of culture and traditional beliefs. It is characterised by safe and healthy work practices and it strikes a balance between the interests of individuals, employers and society. It requires effective change management, clear and realistic performance indicators, matches the work to the individual and uses transparent productivity metrics.”

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7
Q

What are 10 features of “Good Work”?

A
  1. Not the same as ‘ideal job’
  2. Safe, secure, satisfying and comfortable
  3. Autonomy, control and task discretion
  4. Fair rewards for efforts
  5. Varied; opportunities to use and develop new skills
  6. Social relationships which are supportive
  7. Stimulating, challenging and health promoting
  8. Good jobs help people to be ‘resilient’
  9. Effective and supportive line management
  10. Feeling valued and respected team member

Need to balance having a dream job with being a healthy job

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8
Q

What are 6 consequences of unemployment?

A
  1. Increased rates of mortality from CVD and suicide;
  2. Poorer general health – physical and mental;
  3. Increased rates of: CVD, lung cancer; and susceptibility to respiratory infections;
  4. Somatic complaints;
  5. Loss of identity and self-worth
  6. Disability and higher rates of medical consultation, medication consumption and hospital admission
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9
Q

What happens when a person cannot work due to injury or illhealth?

A
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10
Q

What are 6 questions to ask of what happens to you when you become sick or injured?

A
  1. Do you have access to rehabilitation? If so, who pays?
  2. Do you have access to wage replacement if unable to return to work (RTW) immediately?
  3. Does your employer have to provide alternative suitable duties?
  4. Does you employer have to keep your job open while yoy recover?
  5. Does this vary with the country? Hong Kong, Singapore, US, Canada (Varies between countries)
  6. What happens in Australia?
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11
Q

What are 4 factors that access to financial support depends on?

A
  1. Mechanism of injury: work-related, road traffic crash, sport. There is specific legislation that governs access to financial support which comes with employee and employer obligations;
  2. Employment status: if self-employed you may be able to access Income Protection if insured;
  3. Where you live and where injury occurred: some countries cover all citizens regardless of mechanism of injury eg New Zealand has a ‘generic health care system’;
  4. Employer – some employers will cover both work-related and non-work related injuries for time off work and return to work

To find out, ask the patient

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12
Q

Where are compensable patients treated?

A

Majority of patients with a compensable injury will be managed in the private health sector:

  • a compensable injury is a work-related or road traffic crash incident

Public Health system manages

  • complex injuries eg Head injuries, spinal injuries, burns
  • Acute management of Whiplash, fractures but then rehab occurs in private health sector
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13
Q

What are 4 characteristics of a road traffic crash?

A
  1. Each jurisdiction of Australia has an Act & Regulations to provide CTP Insurance to claimant for injuries sustained by the injured party ONLY
  2. This is a FAULT based scheme – at fault driver is NOT covered by CTP insurance scheme
    • ​Eg. the one that caused the “crash” is not covered​
  3. CTP Insurer (for the at fault driver) pays for private hospital, medical and pharmaceutical expenses reasonably and appropriately incurred because of the injury
  4. No wages paid in QLD CTP cases & Employer not required to keep job open
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14
Q

What are the most common injrueis for riad traffic crash?

A

Most common injuries are Whiplash (71% of all claims in QLD) and of minor severity

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15
Q

What is the goal for post-road traffic crash?

A

Goal is return to preinjury function as not all claimants are workers eg children, students, retired people

Medical certificate required for Physiotherapy payments

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16
Q

Why do we have Workplace Compensation and Rehabilitation Legislation in Australia?

A

Harry McShane, age 16, 1908.

Pulled into machinery in a factory in Cincinnati. His arm was ripped off at the shoulder and his leg broken.

No compensation paid; no rehabilitation

Workers compensation is a ‘safety net’ for workers

MANDATORY IN AUSTRALIA

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17
Q

What is Workers’ Compensation Injury?

A

Each jurisdiction of Australia has an Act & Regulations to provide workers rehabilitation and compensation for injuries sustained at work – all operate as a NO FAULT system (ie you receive compensation whether you caused the injury or not)

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18
Q

How mant compensation systems are there in Australia? What are 4 other schemes?

A

Rehabilitation & Worker’s Compensation Legislation

There are 11 compensation systems in Australia

Each state and Territory has its own laws

  1. Comcare (Government workers)
  2. Military Rehabilitation and Compensation Act (ADF)
  3. Seafarers Rehab and Compensation Act 1988 and, Seafarers Rehabilitation and Compensation Act 1992
  4. Mining Industry in NSW has its own workers compensation legislation
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19
Q

What are 5 characteristics of Worker’s Compensation in Australia?

A
  1. a ‘no-fault’ insurance scheme which protects both the worker and their employer in the event of a work-related injury or disease
  2. It covers 2 million employees and 186,000 employers
  3. Funded by premiums employers pay
  4. Premiums based on industry, number of employees and claims history
  5. QLD has the lowest average premium rate in Australia
20
Q

What is the epidemiology of Wc injuries?

A

SOFT TISSUE INJURIES –> Most common work-related injury

102, 260 serous WC injuries

Men 6.2 : Women 4.9

21
Q

Is a professional sports person covered by WorkCover? Who are persons who are NOT workers? What are 4 types?

A

No

A person who performs work under a contract of service as a

professional sportsperson is not a worker while the person is:

  1. participating in a sporting or athletic activity as a contestant; or
  2. training or preparing for participation in a sporting or athletic activity as a contestant; or
  3. performing promotional activities offered to the person because of the person’s standing as a sportsperson; or
  4. engaging on any daily or other periodic journey in connection with the participation, training, preparation or performance.
22
Q

What are 6 characteristics of WorkCover in Australia?

A
  1. Government owned workers compensation insurer called “WorkCover” (differs in each State)
  2. Also 28 Self-insurers eg Coles, UQ, Woolies, banks
  3. 90,000 claims /year lodged in the Queensland workers’ compensation scheme
  4. 0.1% of claims are result in fatal injuries
  5. Less than 3% of claims progress to common law
    • Sue employer for negligence (eg. did not ensure equipment was safe, did not correct train workers for safe work)
  6. Majority are musculoskeletal injuries to the low back
23
Q

Who is eligible for injuries to be covered?

A

Every worker, volunteers, work experience students

24
Q

What types of injuries are covered?

A

“An injury is a personal injury arising out of, or in the course of employment if the employment is a significant contributing factor to the injury”

eg asbestosis, aggravation of a pre-existing injury or disease (e.g. OA), hearing loss, death, psychological injury and travel between home and place of employment

25
Q

What are 4 reasons why not all injured workers report an injury?

A
  1. Fear of stigmatisation eg Mental health condition OR ‘invisible’ injuries – is the worker malingering? or have a ‘compo back’, ‘Mediterranean back’
  2. Fear of job loss or pressure from management due to additional costs associated with claims
  3. Fear of reprisals from co-workers who may have to work harder/longer to cover the work the injured worker cannot do. Loyalty to their co-workers - ‘letting down the team’!
  4. Fear of reprisals from supervisors – injured workers may not be given extra shifts, given ‘boring’ monotonous job
26
Q

What are 4 things that the QLD workers compensation insurers pay?

A
  1. Income replacement while worker recovers
  2. Medical treatment, medication, surgery, travel for appointments, rehabilitation, appliances eg prostheses, aids
  3. Death benefits including special provisions for children and funeral costs
  4. Lump sum for permanent impairment calculated by a “table of injuries” where max ~$575,765 (death); loss of body part; loss of efficient used of body part, disfigurement, pain/suffering
27
Q

What are statutory benefits (ie. Income replacement in QLD workers compensation scheme)?

A

Still don’t get full wages –> want to get back to working ASAP

28
Q

When does compensation begin in Queensland?

A

The day the worker assessed by:

  • Medical Practitioner, or
  • dentist – oral injuries, or
  • nurse practitioner
  • No other state in Australia gives Nurse practitioner authority to certify
  • Victoria – Physios can provide ongoing Work Capacity Certificate
29
Q

When does the workers compensation claim in QLD end?

A
  • When there is no medical certificate
  • When the worker has RTW or is recovered
  • When a medical tribunal says so
    • Tribunal: the claim has reached a plateau (certain point)–> gets re-evaluated by specialist (if they have ongoing, recurrent injury)
  • When progress has plateaued – then assessed for Permanent impairment
  • When worker not complying eg not turning up for appointments
  • After 5 years but most settle within 2yrs
  • QLD has a ‘short tail’ scheme ie claims settled within 2 years
30
Q

What are 5 damages in the common law claim?

A
  1. If the worker feels their employer was negligent and to blame for the injury, they may sue their employer for damages.
  2. The onus of proof of negligence is on the worker.
  3. Damages claims are determined by a court
  4. Less than 3% of claims proceed to common law
  5. Average Common Law cost 2015/16 $146,571 – Employers take steps to avoid this (ie have good injury prevention mechanisms, comply with legislation)
31
Q

What are RTW stakeholders?

A

any person, organisation or agency that stands to gain or lose based on the results of the RTW process

  • Stakeholders supporting return to staying at work with a health condition
32
Q

What do most compensation systems involve some or all of these stakeholders?

A
33
Q

What are stakeholders have shared goal but different perspectives?

A
34
Q

What are the 6 obligations of the employer, under workers compensation?

A
  1. Keep job open for 12months (ie cannot dismiss a worker solely because of the injury)
  2. keep regular contact with the worker and Insurer customer advisor
  3. Identify and provide duties of suitable standard
  4. monitor the worker’s progress
  5. provide a supportive environment—be understanding of co-workers
  6. If the employer considers it is impractical to provide the worker with suitable duties, the employer must give WorkCover QLD evidence of this
35
Q

What are 2 obligations of the injured worker?

A

“mitigate their loss” ie participate in treatment, rehabilitation and return to work programs’

Failure to do so may result in damages being reduced – Physio needs to notify insurer/Dr that the worker is not adhering to recommended rehab

36
Q

What are 5 obligations of the insurer?

A
  1. Provide and/or manage indemnity policies for employers
  2. Process and manage (workers’ compensation) claim (Within certain time frame)
  3. Advise claimants and employers of acceptance of liability or otherwise or of any changes to claim status
  4. Payment of all entitlements to employees according to the legislation
  5. In QLD workers comp system, the insurer will pay for a maximum of 5 physiotherapy sessions without prior approval (this varies with every state and compensation system)
    • Any more than 5 session –> request in writing (average no. =5)
37
Q

What are the 5 principles in the role of physio (deliver treatment according to the Clinical Framework)?

A
  1. Measurement and demonstration of the effectiveness of treatment
  2. Adoption of a biopsychosocial approach
  3. Empowering the injured person to manage their injury
  4. Implementing goals focused on optimising function, participation and return to work
  5. Base treatment on best available research evidence
38
Q

What are 7 questions to ask the patients who have work injuries?

A
  1. Where did injury happen – work related or MVA?
  2. Do you have a medical certificate? If not, treatment may not be covered by insurer
  3. Are you an employee or self-employed?
  4. What do you do for a living?
  5. What are the physical demands of your job?
  6. Does your employer have a rehabilitation coordinator who can assist in sourcing alternate duties?
  7. If patient cannot return to usual duties – what can they do? – communicate this to referring Dr
39
Q

What are 3 characteristics in QLD WC, if >5 treatment sessions are required?

A
  1. An insurer may require the Provider management plan to be provided either verbally or in written format.
  2. Check with each insurer as to their individual requirements
  3. In QLD, the WC Insurer will not pay for the preparation or completion of a Provider management plan (Bb)
40
Q

What services do PT’s provide to an injured worker?

Go to this website below to find out what a Physiotherapist can charge for these services:

  • Initial consultation = $
  • Subsequent in rooms consult x 1 area = $
  • Initial setting up exercise program =$
  • Group exercise class = $
  • Reports – progress, standard, comprehensive =$
  • Communication 3- 10 mins = $
  • Travel = $
A
  • Initial consultation = $87
  • Subsequent in rooms consult x 1 area = $57
  • Initial setting up exercise program =$183/hr
  • Group exercise class = $
  • Reports – progress, standard, comprehensive =$61-183
  • Communication 3- 10 mins = $30/10mins
  • Travel = $134
41
Q

What are 5 characteristics of a treating medical practioner?

A
  1. Gatekeeper of compensable process
  2. Provides the initial medical certificate for WC insurer to activate the claim
  3. Diagnosis, provide medical treatment, referral for specialist intervention
  4. Approves RTW / Suitable Duties Plan
  5. Workers’ Compensation system is run under a medical model
42
Q

What is a Workplace Rehabilitation & RTW Coordinator?

A
  • Usually an employee of the organization (or contracted) who assists with claim lodgment, application for income support, statement from the worker, maintains contact with worker
  • Works with the worker and Dr to establish appropriate rehabilitation strategies to facilitate RTW
43
Q

What are 7 roles of insurer claim manager/customer advisor?

A
  1. guide the return to work process
  2. communicates with all parties
  3. focuses on what the worker can do
  4. helps find tasks the worker can do
  5. monitor the progress of the worker
  6. approves and reimburses the costs of rehabilitation
  7. This person may or may not have Tertiary or Health qualifications
44
Q

Returning to work with an injury can be ______ due to the many compensation systems and many stakeholders

A

complex

45
Q

Always ask what the patients ____ and _____ for rehab

A

job; goals

46
Q

Physiotherapist’s role varies in each ____ and _____ so become familiar with the expectations in the jurisdiction where you work

A

state; country

PHTY3280 (17 decks)

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