INJURY MANAGEMENT

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INJURY MANAGEMENT
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AGENDA

• Define Injury Management
• Discuss Elements of Injury Management
• Risk Management
• Facilitation of Return to Work
• Medical Treatment
• Economic Costs
• Generic Case Management Model

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What is Injury Management?

• Prevention of injuries
• The return to work of an injured person
• The medical treatment of an injured person
• Control of economic factors that impact on an
  insured party

Involves the total management process of personal
injury that includes the
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PREVENTION OF INJURIES

• Number One

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PREVENTION OF INJURIES
How do we prevent injuries?
A Risk Management program
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Risk Management Program

• Purpose
• To effectively manage Occupational Health and
  Safety by

(a) regularly reviewing and identifying any
potential workplace hazards (b)
assessing the risks associated with them (c)
implementing control measures to effectively
eliminate or reduce the risk.
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Risk Management

• Involves
• Hazard Identification
• Risk Assessment (of hazards identified)
• Risk Control
• Review of Outcomes

The co-operation of employees is vital in
identifying hazards so that effective control
measures can be put in place.
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Risk Management

• Hazards may be identified via
• Analysis of injury, accident and near miss data.
• Consultation with employees.
• Walk through surveys and hazard inspections.
• Hygiene monitoring reports.
• Occupational Health and Safety Reports.
• Material safety data sheets.
• Sickness records.
• Analysis of Regulations, Codes of Practice,
  Australian Standards

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Risk Management - Basic Hazards

• Gravity
• Falling objects people
• Mechanical Energy
• Moving plant, equipment, machinery
• that can crush.
• Biological
• Blood / body organs
• Human waste
• Animal waste
• Manual Handling
• Reaching
• Awkward Postures
• Lifting

• Hazardous Substances
• Gases, dusts, mists fumes
• Flammable materials
• Poisonous substances
• Thermal Energy
• Extremes of heat cold in working environment,
  and in substances used
• People / Tasks
• Fatigue
• Stress
• Job Design

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Risk Management

• Involves
• Hazard Identification
• Risk Assessment (of hazards identified)
• Risk Control
• Review of Outcomes

The co-operation of employees is vital in
identifying hazards so that effective control
measures can be put in place.
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Risk Management

• Involves
• Hazard Identification
• Risk Assessment (of hazards identified)
• Risk Control
• Review of Outcomes

The co-operation of employees is vital in
identifying hazards so that effective control
measures can be put in place.
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Hierarchy of controls

• Elimination
• Substitution
• Engineering Controls
• Isolation
• Enclosure
• Containment
• Administrative Controls
• Personal Protective Equipment

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Risk Management Activities Following Injury
Injury
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RETURN TO WORK

• Number Two

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WHAT IS A RETURN TO WORK?

• Maintaining or returning a worker to their
  original job, on partial or full hours
• OR
• Returning an injured worker to work on modified
  or alternative duties on partial or full hours
• OR
• Returning a worker to work but not at their
  injury employer (job seeking)

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Return to work the Law

• Under Section 122 of the Accident Compensation
  Act, the employer is required to provide
  suitable employment for the first 12 months
  after the first day of commencement of weekly
  payments, whether the worker is capable of full
  or partial duties
• Failure to comply with requirements to provide
  employment (Sec 242 of the Accident compensation
  Act) can lead to prosecution in the Magistrates
  court and fines up to 25,000

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Facilitating a Return To Work

• Developing a RTW plan
• A documented individual action plan (prepared in
  accordance with medical advice) and developed to
  maintain the injured workers at work or return to
  work after injury. It provides details of
• Suitable duties
• Medical restrictions
• Treating practitioners details
• RTW goals
• Any assistance to be provided to the injured
  worker, catering for any special needs

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5 Steps to developing RTW plan

• Review jobs at the workplace
• Assess jobs inline with medical capacity
• Decide if the jobs are suitable
• Document plan and send to Treating Health
  Practitioner for endorsement
• Offer the worker the RTW plan

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Workers response to formal offer of RTW plan

• Employers can request workers to respond in 14
  days to either accept or reject the RTW offer
• Response should be in writing
• The offer should include documentation stating
  that failure to respond will be taken as
  non-acceptance of the offer
• If non-acceptance is considered unreasonable,
  action should be taken to reduce, or terminate
  weekly payments (consult WorkCover Insurer).

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Number ThreeMedical Treatment
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Approved practitioners for the worker

• General Practitioners family doctor
• Specialists
• Exercise Physiologists
• (AAESS Accreditation Required)
• Physiotherapists
• Occupational Therapists
• Chiropractors
• Osteopaths
• Remedial massage therapists
• Acupuncturist
• Hand Therapist

These need to be registered with the VWA
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CASE EXAMPLE Back Injury

• Worker sustains back injury
• GP
• Physiotherapist
• Specialist
• Multidisciplinary program

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Independent Medical Assessments

• Section 112 examiners
• Medical Specialists orthopaedic, rheumatology,
  neurology, psychiatry, musculoskeletal,
  occupational physician (workplace assessment),
  general surgeon, plastic, dental
• Physiotherapist
• Chiropractor

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Number FourEconomic impact
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Case Study

• Mark is 45 years old and is a little unfit
• Worked in a warehouse for the past 11 years
• He has seen numerous changes, although he is
  sceptical of the results of changes
• Marks supervisor found it hard for Mark to try
  new approaches and felt Mark had a bad attitude
• One day Mark and his supervisor argued about a
  change in a procedure. Both became irate towards
  one another.
• Later in the day, Mark was reaching for a box on
  the shelf and twisted his back and felt a painful
  stab.
• Mark put in a WorkCover claim, which has been
  accepted.

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What happens without a return to work approach?

• Mark goes to the doctor to obtain WorkCover
  certificates
• He is certified unfit for work for 1 month
• There is no contact from work to see how he is
  going
• A friend from work tells him that someone has
  been hired for his position on a temporary basis
• Mark is worried that he would never be able to do
  his old job again and feels his employer wasnt
  too interested in having him back
• The insurer contacts the employer and the
  employer informs them that they dont want Mark
  back until he is fully fit for his pre-injury
  job.
• After 3 months Marks back still hurts. He has
  been referred to a rehabilitation program and
  over several months he regained some capacity for
  work
• At 6 months there were still no return to work
  opportunities at his employer, the insurer refers
  him to occupational rehabilitation.
• 8 weeks later he was hired at a retail outlet on
  a WISE placement program.
• Mark was off work for a total of 8 months, his
  marriage suffered and so did his friendship with
  the people at work

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What happens with a return to work approach?

• Marks supervisor sees that Mark is in pain after
  the initial injury and asks a co-worker to drive
  him to the doctor.
• The supervisor calls Mark up to see how he was
  going after his doctors visit
• Mark informs his supervisor that he will be unfit
  for a few weeks.
• As the RTW co-ordinator of the business, the
  supervisor prepares a return to work plan.
• For the next few days, the supervisor made sure
  the co-workers called Mark to tell him about the
  social news as well as the company news.
• The supervisor keeps in touch with Mark and talks
  about modifying his job so he could return to
  work when he is able to.
• The supervisor phones Marks doctor up to inform
  them that Marks job can be modified.
• A couple of weeks later, Marks condition
  improves and the supervisor invites Mark to the
  workplace to talk about his return to work.
• They develop a return to work plan together which
  they both signed off and then sent to the
  treating doctor. The doctor signs the plan.
• Mark returns to work on a graduated basis after 2
  weeks.

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FINANCIAL COSTS

• WITHOUT A RTW APPROACH
• 8 months workers compensation
• payments (PIAWE 600) 15,960
• Occupational rehab 3,330
• Multidisciplinary program 3,000
• WISE program
• (12 months wage subsidy) 10,430
• Medical treatment 6,500
• Other claims costs 60,000
• TOTAL 99,220

• WITH A RTW APPROACH
• 12 weeks of weekly
• compensation including
• partial comp 4,902
• Medical visits and ongoing
  treatment 2,000
• TOTAL 6,902

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HUMAN COSTS

• WITHOUT A RETURN TO WORK PLAN
• Mark lost his job
• He is in marriage counselling with his wife
• Some of his co-workers think he is faking his
  injury
• Some co-workers are angry with the company for
  doing little to help Mark
• Mark develops secondary psychological issues

• WITH A RETURN TO WORK PLAN
• Mark feels he is important to the company
• The other co-workers can see the company cares
• Increased morale in the workplace
• Increased productivity

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Injury Management

• How the WorkCover Insurer can help you

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At WorkCover Agents, each claims team has

• A Health Medical Specialist (HMS) employed part
  time

An Injury Management Adviser (IMA) employed
full time
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Health Medical Specialists

• Musculoskeletal physicians
• General surgeons
• General Practitioners specialising in
  Occupational Medicine
• Emergency Registrars
• Sports Medicine Physician

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Health Management Specialists

• Assist team members in understanding medical
  issues of claims.
• Review reports treater reports and independent
  medical (112) reports.
• Make recommendations regarding assessment and
  treatment.
• Monitor of pharmaceutical issues types of
  medicines prescribed and costs.
• Contact other medical practitioners (General
  Practitioners, Surgeons, Specialists).

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Injury Management Advisers

• Physiotherapy
• Exercise Physiologists
• Occupational Therapy
• Human Movement
• Nursing
• Occupational Rehabilitation
• Occupational Health and Safety

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Injury Management Advisers

• Advise the case manager on appropriate treatment,
  rehabilitation and other services with a focus on
  early recovery and return to work
• Assist the case manager regarding timely
  referrals for rehabilitation
• Identify Red Flags
• Back injuries
• Overuse injuries
• Stress
• Major trauma crush injury, amputation, head
  injury

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Injury Management Advisers

• Complete initial contacts and risk reviews with
  worker, employer and medical practitioner on
  receipt of new claims.
• Review claims at 4, 9, 15 and 20 weeks (from most
  recent cease work dates).
• Attend multidisciplinary team meetings to review
  individual claimants.
• Complete monthly reviews of Occupational
  Rehabilitation services for individual
  claimants.

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Resources for Injury Management Advisors

• HMS
• Independent Medical Examinations
• Occupational Rehabilitation Providers
• Multidisciplinary programs such as spinal
  management, chronic pain, sprains and strains
  program.

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Example 1 Tom

• 32 year old male
• Employed as animal catcher
• Small employer
• Injured left knee whilst at work, 24/07/03

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Case Study Tom cont

• Off work 2 weeks
• Attempted RTW- lasted 1 day
• Then off work no end in sight
• Reviewed at Multidisciplinary Team Meeting

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Case Study Tom cont

• Referred to Occupational Rehabilitation to
  establish Toms
• Current medical and status
• Functional abilities and limitations,
• Medical intervention required
• Demands of pre injury duties
• Availability of alternative duties.

OR provider would meet with employer and worker,
and also talk with general practitioner
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Case Study Tom cont

• OR provided feedback that there were no
  alternative duties, however Tom was likely to be
  fit in the near future.
• GP must have had some concerns as he had referred
  Tom to a specialist. Tom was scheduled to attend
  review with specialist earliest appointment mid
  October.
• In the meantime independent medical (112) had
  stated that Tom required arthroscopy.

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Case Study - Outcome

• W With HMS intervention, obtained earlier review
  and arthroscope completed 2nd October
• N
• N
• N
• NNow awaiting recovery to facilitate a RTW as
  soon as medically cleared

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Summary

• You must be committed to effective Injury
  Management
• WorkCover agents can provide you with the
  resources to optimise the Injury Management
  aspect of your claims
• A large focus of Injury Management is on return
  to work

Employer involvement is critical for a
sustainable return to work