Roles in the claims process
There are different roles which play a part in helping an employee with an injury or illness return to health and work, where possible. Each role has responsibilities.
Employees who make a claim
Report details of any accident, injury or illness that may be related to your work to your employer.
Attend medical examinations which your claims manager arranges.
Participate in the return to work process. This includes co-operating with your employer, rehabilitation case manager and rehabilitation provider. They will work with you to achieve a full return to work where appropriate.
Notify your claims manager if:
- your personal circumstances change. This includes changes to your:
- number or circumstances of your dependants
- employment, whether voluntary or otherwise
- medical condition
- bank account details, if compensation payments are made directly into your bank account
- you, your dependants, or another person, start legal action about your work-related injury or illness. This must be done in writing within seven days of starting the legal action
- you become aware that you have made a misleading statement, such as on a claim form. False or misleading statements may lead to delays in a decision on the claim. In certain cases, it may also lead to action being taken under the Crimes Act 1914.
- Employees and other workers – role and responsibilities
When you sustain a work-related injury or illness, your employer:
- must take reasonably practicable steps to ensure the health and safety of you and others. This may include:
- making changes to the workplace to minimise the chance of further injuries or accidents
- assessing your needs and directing you to the necessary and appropriate support and help
- should provide you with claims information, including relevant forms and advice about processes and procedures.
If you submit a claim, your employer:
- must work with the claims manager to support an accurate and timely determination of your claim
- must comply with privacy obligations as they relate to your claim
- should support you to return to health and safely remain at or return to work, where possible.
- Middle managers and supervisors – role and responsibilities
- Senior managers and executives – role and responsibilities.
Claims managers assess and manage claims for compensation.
Your claims manager works with you, your employer, treating medical practitioners and rehabilitation case manager to support you to:
- return to health
- where possible, safely remain at or return to work.
Your claims manager supports you throughout the claim process.
- Claims managers – role and responsibilities
Rehabilitation case managers
The rehabilitation authority, who in most cases is your current employer, is responsible for assigning a rehabilitation case manager to you. This happens in many workplaces at the time you submit a claim for compensation.
A rehabilitation case manager works with you to coordinate and manage your rehabilitation and return to work process.
They help to plan, organise, coordinate, monitor and evaluate services and resources for you.
In the Comcare scheme, legally qualified medical practitioners include both:
- general practitioners (GPs)
- medical specialists, such as orthopaedic surgeons, psychiatrists and dentists.
The main responsibilities of a medical practitioner in the claims process are to:
- assess and diagnose injury or illness
- provide treatment
- refer for specialist treatment
- assess work capacity and give medical certification
- provide advice on alternative duties or workplace modifications.
- Medical treatment and medical evidence
- Medical practitioners provides information for medical practitioners.
Allied health professionals
An allied health professional is a health professional that is not part of the medical, dental or nursing professions.
They are qualified practitioners with specialised expertise in preventing, diagnosing and treating a range of conditions and illnesses.
Allied health professionals include:
- Rehabilitation services – information for employees
- Allied health professionals – information for allied health professionals.
Workplace rehabilitation providers
Workplace rehabilitation providers are organisations accredited to deliver workplace rehabilitation services to help injured employees return to work.
Prescribed workplace rehabilitation services include:
- initial workplace rehabilitation assessment
- assessment of the functional capacity of an employee
- workplace assessment
- creating and monitoring a rehabilitation or return to work plan
- creating suitable duties plans
- job analysis
- advice about job modification
- rehabilitation counselling
- vocational assessment
- advice or assistance in job seeking
- advice or assistance in arranging vocational re-education or retraining.