Medical practitioners

Diagnosis

For a claim to be accepted, there must be a clear diagnosis from a medical practitioner.

Under the Safety, Rehabilitation and Compensation Act 1988, a legally qualified medical practitioner can be a general practitioner or a specialist, such as a surgeon, psychiatrist or a dentist.

A claims manager may contact you, as the treating medical practitioner, if they need more information about an employee’s injury or illness.

Contact is often made in writing and the claims manager will ask you to provide a written response. In some cases, a phone call may be enough to clarify an issue.

If you want to discuss any matter related to an employee’s claim, you can contact the claims manager to discuss the case.

For more information, see Assessing a claim and Claims manager role.

Assessing work capacity

When assessing capacity, it is important to focus on what the employee can do, not what they can’t do.

This information is included in the medical certificate, which is a form of medical evidence. Comcare’s preferred medical certificate is the certificate of capacity.

The certificate of capacity:

• provides information on the employee’s injury or illness, diagnosis and recommended treatment
• assesses the capacity of the employee and certifies capacity to work
• sets expectations early about timeframes for recovery and safe stay at or return to work
• is used by the employee’s rehabilitation case manager and employer to look for and offer suitable duties that fit the employee's functional abilities
• the certificate of capacity can be updated as the injury, medical condition or capacity changes.

Claims managers will generally not accept backdated certificates of capacity.

When assessing work capacity for patients with a psychological condition, watch a video featuring Consultant Psychiatrist Dr Dielle Felman.

Return to work case conferences

You may be required to be involved in a return to work case conference.

Return to work case conferences connect professionals and others involved in an employee's illness or injury to discuss and support the employee’s rehabilitation and return to work process.

For more information, see Case conferences and Billing for a return to work case conference.

Clinical reviews

A clinical review is an internal claims management process.

Reviews are a cooperative and collaborative process between medical practitioners and members of Comcare's clinical panel.

As part of a review, the clinical panel assesses information on an employee’s claim file and asks medical practitioners to provide information.

For more information, see:

• Clinical panel and clinical reviews
• Why Comcare may Review your Patient's Claim for Compensation information sheet (PDF, 93.1 KB).

Independent medical examinations

Independent medical examinations may be conducted where additional medical information or specialist opinion is required to support the decision making and management of the claim. As a treating health practitioner, you may be contacted by the independent medical examiner to discuss aspects of the employees’ condition or treatment.

For more information see Independent medical examiners.

Working with mental health conditions

Medical practitioners are increasingly required to diagnose, treat and assess work-related mental health conditions.

The following resources are useful guides:

• Work-related Mental Health guidelines for general practice – to assist with diagnosing and treating work-related mental health conditions.
• Post-traumatic Stress Disorder (PTSD) guidelines – information about the most effective treatments for PTSD.
• Post-traumatic stress disorder treatment – Black Dog Institute.

Watch a video on how to assess capacity for patients with a psychological condition

Assessing capacity for patients with a psychological condition is a video featuring Consultant Psychiatrist Dr Dielle Felman which provides information and recommendations for assessing work capacity for patients with a psychological condition.

Adapted for national use with the support of WorkSafe Victoria.

Transcript of Assessing Capacity for Patients with a Psychological Condition video

Support available to injured and ill employees

A range of support and payments are available to help an employee return to health and to work.

Employees who have a compensable claim under the Safety Rehabilitation Compensation Act 1988 may be able to claim:

• Medical treatment
• Rehabilitation services
• Aids, appliances and modifications
• Household and attendant care services
• Income support
• Travel costs
• Long-term injury or impairment benefits.

Rates of payment

Rates for medical and allied health treatment outlines the upper fee limits for medical services.

How providers are paid

There are two ways you can be paid:

1. through the claims manager (preferred method), or
2. by the employee.

Through the claims manager

If the employees claim is managed by Comcare, you can submit their relevant medical services invoices for payment in three ways:

• Digitally via Medipass - This is our preferred invoicing method, and the quickest way to get paid
• by email at  general.enquiries@comcare.gov.au
• by post to Comcare, GPO Box 9905, Canberra ACT 2601

If you submit your invoices to Comcare digitally through Medipass, payment is usually next business day for approved invoices. For invoices submitted by email or post payment will take longer.

See more information on what to include on your invoice and if to apply Goods and Services Tax.

If the employee’s claim is managed by a self-insured licensee, you should work directly with the licensee.

Remember, only submit invoices after services have been provided.

By the employee

Where necessary, you can seek payment directly from the employee receiving the service. The employee can then seek reimbursement from their claims manager.

For more information, see Reimbursement - Receipts.

Invoicing for case conference participation

Comcare uses the Australian Medical Association (AMA) rates (available to AMA members or by subscription) to pay invoices related to participation in a case conference.

Invoices for participation in a return to work case conference must include the following key information:

• the service provided, namely return to work case conference
• general medical practitioner provider number
• fee charged or AMA item number.

More information on what to include on the invoice is available on the invoicing and payment page.

Resources for treating health practitioners

Comcare produces resources for GPs and allied health professionals that provide information relating to treating employees with work-related injury or illness.

Comcare endorses the Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB). The framework outlines a set of guiding principles for the delivery of health services to injured or ill employees.

Guidance on assessing a patient’s capacity for work

As a GP you are responsible for assessing your patient’s functional capacity for work if they are an employee with an illness or injury. Enabling your patient to participate in good work while they recover results in better health and wellbeing outcomes.

Evidence-based assessment should consider both physical and psychological functions and focus on what the person can do, not what they can’t do. This guide will help you to assess a patient’s functional capacity for work and provide guidance on work modifications, where capacity exists.

Download the Guide for GPs on Psychological Assessment (PDF, 93.5 KB) and share with your networks.

Comcare acknowledges the work undertaken by Dr Dielle Felman and Dr Peter Cotton on assessing capacity to work for patients with psychological conditions was a key resource for this guide. Watch a video featuring Dr Dielle Felman and including more information.

Webinar recording: Assessing functional capacity to work for psychological injuries

Facilitating good work for your patient

Participation in ‘good work’ is key to recovery and we know that it often takes a team effort to get it right. There are steps you can take to help your patients to access good work that supports their recovery and doesn’t pose further harm to health. This guide (PDF, 93.5 KB) is designed to assist you to talk with your patients about what good work looks like for them and provide advice on reasonable adjustments that address work issues, preferably in collaboration with the workplace.

Guide for GPs to manage work related injury

As a GP you play a vital role in the rehabilitation and return to work of people who have been injured at work, including promoting the health benefits of good work and advising on work capacity.

This guide will help you manage the recovery pathway for an injured worker and provide key timeframes to consider within the claims process. Understanding roles and timeframes in the return to work process can assist you to outline expectations for your patients.

Download the Guide for GPs to manage work related injury (PDF, 104.5 KB) and share with your networks.

Snapshot – Principles on the role of the GP in supporting work participation

A one-page snapshot summarising the Principles on your role as a GP in supporting work participation has been developed. The snapshot provides a summary of the three key roles for GPs in supporting work participation for people with injury, illness or disability.

The Principles on the role of the GP (PDF, 6.9 MB) in supporting work participation is officially recognised as a Supported Position Statement by The Royal Australian College of General Practitioners. The work to develop the Principles was led by the Australasian Faculty of Occupational and Environmental Medicine on behalf of the Collaborative Partnership to improve work participation.

Download the one-page Snapshot: Principles on the role of the GP in supporting work participation (PDF, 1.4 MB).