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Clinical panel and clinical reviews

For: Claimants Employers and managers Service providers Advocates

Comcare has a clinical panel which carries out clinical reviews and provides clinical support to claims managers.

The panel may also offer advice to medical practitioners and allied health professionals treating an employee with a claim.

Role of the clinical panel

The clinical panel provides advice and conducts clinical reviews to help make sure employees with a claim receive the most appropriate treatment for their injury or illness.

The panel aims to improve decisions concerning a claim and improve return to work and health outcomes.

To achieve this, the clinical panel is made up of experienced and independent medical practitioners and allied health professionals who work as:

  • general practitioners (GPs)
  • physiotherapists
  • pharmacists
  • psychologists.

Clinical reviews explained

A clinical review is an internal claims management process, usually initiated at the request of the claims manager.

A review is a cooperative and collaborative process between the treating healthcare providers and members of the clinical panel.

Purpose of a clinical review

The focus of a clinical review is to make sure treatment is clinically justified.

The Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB) describes ‘clinical justification’ and what this means.

After completing a review, the clinical panel provides recommendations to the claims manager.

Communication with the employee

Being involved in a review is a normal part of the claims process.

Employees are informed if their claim is referred to the clinical panel for a review and are advised of the reasons.

What happens as part of a review

As part of a clinical review, the clinical panel:

  • assesses information on an employee’s claim file
  • asks healthcare providers to supply information about the employee with a claim.

A review may include phone conversations between the treating medical practitioner or allied health professional and a relevant clinical panel member about an employee's current and future treatments.

If the clinical panel member and provider do not agree on treatment, the employee may need to attend an independent medical examination.

Page last reviewed: 03 December 2019
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Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 29 Sep 2020

https://www.comcare.gov.au/claims/assessing-claims/clinical-panel