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Early Intervention FAQs

The old guidelines (Guidelines 2005) referred to 10 days as a trigger for a rehabilitation assessment, whereas the new Guidelines say three days. Why is this?

The Guidelines say: “The case manager, in identifying the potential for early rehabilitation intervention, should have regard to… (d) any workplace absences, especially any unplanned absence of three or more days”. It is not a requirement that the assessment take place exactly after three days, because not all relevant information may be available. However, there should be a system in place that allows the case manager to be informed of that level of absence within a reasonable amount of time. By then, the case manager can make a valued consideration of whether or not to arrange an assessment.

It is the delay in receiving that advice that motivated the choice of three days instead of the original 10 days. Under the 2005 Guidelines, the 10 day absence meant that consideration of an assessment may not take place until the third week of absence, and lose the value of early intervention. Under the new Guidelines, an assessment could be considered within a week (many case managers make that decision the moment an incident report is received, even if it is within three days). The case manager should make a record on file of that consideration when deciding not to proceed with arranging an assessment, which will satisfy audit purposes.

Why can early rehabilitation intervention take place prior to liability?

Comcare has had the policy of allowing early rehabilitation intervention prior to liability since 2001 and the Guidelines give authority to that practice (see Chapter 4, paragraph 17-Early Rehabilitation Intervention of the Guidelines for further information).

It can be explained as follows. Section 14 of the SRC Act is used to determine whether an injury or disease is compensable. Subsection 4(8) states that, unless the contrary intention appears, a reference to an injury is an injury for which compensation is payable under the Act. Section 54 states that a claim needs to be made for compensation—a claim is not made for rehabilitation. Furthermore, the suspension provisions identify compensation entitlement and rights, but not those of rehabilitation. Consequently, rehabilitation is not compensation.

Sections 36 and 37 of the SRC Act allow for the assessment for and provision of rehabilitation where there is an injury resulting in incapacity for work or an impairment. Section 4 defines an injury as having the meaning given under section 5A, as “arising out of or in the course of the employment”. As that decision is made prior to determining section 14 (liability), this can be used as the basis to undertake early intervention prior to liability. Furthermore, incapacity is defined under subsection 4(9) as “an incapacity to engage in work or in the same level of work as was performed prior to the injury”; it also makes no reference to compensation.

The Guidelines for Rehabilitation Authorities 2012 allow in (Chapter 4, paragraph 17.3)

What can be done if an injured worker is non-compliant with rehabilitation prior to liability being determined, that is, where a S36 assessment or S37 rehabilitation program has been developed?

If the employee’s refusal, failure or obstruction to undertake a rehabilitation assessment examination or participate in a rehabilitation program is found to be unreasonable, their rights and entitlements for compensation are suspended in accordance with the SRC Act and that suspension will apply retrospectively to the relevant period when liability is determined. As medical expenses are not suspended, the relevant authority is obliged to determine whether there is liability even during the period of suspension.

Will medical treatment for employees be considered part of early intervention—and will Comcare reimburse such costs even if liability is denied?

Medical treatment costs will only be paid after the determination to accept liability. Consequently, care should be taken to exclude medical treatment from rehabilitation programs prior to the determination of liability. However, any medical treatment costs incurred prior to liability will be paid for by Comcare if liability is accepted.

If you pay for an assessment before determining liability, aren’t you supporting the claim?

The provision of early intervention is not a concession of liability and the case manager should make this statement in writing to the employee when initiating early intervention. Rehabilitation authorities (case managers) are limited to determining matters relating to the assessment for and provision of rehabilitation. The Guidelines support the provision of early intervention where there is evidence of employment contribution to the injury or disease. The case manager should not look beyond that test and is not required to decide whether there is likely to be liability or whether any of the exclusionary provisions apply. That is because the case manager’s delegation does not extend to the question of liability, which falls to the relevant authority.

Are health assessments covered?

Costs of health assessments or fitness for duty examinations are performed under legislation or policies covering the conditions of employment and are payable under those provisions and not the SRC Act. Quite often these assessments and examinations are required due to the employee being unfit for their normal duties as a result of an injury or disease that is unrelated to their employment. Even though the cost of these assessments and examinations is not payable under the SRC Act, the case manager should nevertheless consider those reports as an integral part of the assessment of the employee’s capacity to undertake rehabilitation (see paragraph 18.2 of the Guidelines).

If Comcare doesn’t accept the claim, will early intervention costs still be reimbursed to the employer?

Comcare will reimburse the costs of rehabilitation incurred by a premium payer up to the date that liability is denied.

Should an assessment conducted prior to determination be a business or claims cost for a licensee?

Whether the cost of pre-liability determination is a business or claims cost is a corporate decision. It is recommended that prior to liability, rehabilitation is a business cost that is reimbursed as a claims cost after liability is accepted.

Page last updated: 20 Mar 2014