ACCforum: any info on these Assessors ? - ACCforum

Jump to content

Page 1 of 1
  • You cannot start a new topic
  • You cannot reply to this topic

any info on these Assessors ?

#1 User is offline   Jack 

  • Member
  • PipPip
  • Group: Members
  • Posts: 22
  • Joined: 26-February 07

Posted 26 May 2009 - 12:55 AM

hi
have IOA coming , and have 3 people to pick from

any info would be most helpful
0

#2 User is offline   Fighter for Justice 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 115
  • Joined: 23-August 08

Posted 26 May 2009 - 07:18 AM

Jack, I know nothing about any of these Assessors.

But, having recently been put through Initial Occupational Assessment I suggest checking the following: Does IOA Referral have correct job description, mention all covered injuries, have the correct pre-incapacity earnings figure. The IOA Referral should also mention what information ACC gave the IOA e.g. IRP, prior IOA/IMA etc.
Attached should be a Documentation Sheet: mentioning ALL information given by ACC to Assessor.

Suggest you take all reports which you believe are helpful, type a letter mentioning anything you believe ACC have failed to mention to IOA e.g. require all covered injuries included, correct job description, correct pre-incapacity earnings. Mention your comments regarding previous reports (which ACC given to IOA e.g. previous IOA/IMA Reports, IRP (Deemed or Signed)). I would also put in writing what you believe you want from ACC re Vocational Rehabilitation e.g. what course, tertiary study, help with small business etc and WHY you believe it is cost effective for ACC to provide you with this - (rather than 2 weeks computer training ACC style).

Get Assessor to sign your copy of the typed letter (so they cannot say they never received it)!
Take a witness and a audiotape to IOA - then you have a record of what was said!
I say this as I believe some IOA tape these interviews anyway!

Good luck!
0

#3 User is offline   Sparrow 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 534
  • Joined: 22-March 07

Posted 26 May 2009 - 12:16 PM

Jack, the most important of all is to obtain, BEFORE you go, all the report copies that ACC will be sending to the IOA assessor.
Then you will know what has been deliberately left out.

When you go to Assessment make sure that they do not start mentioning any jobs that are beyond your physical capabilities and training.
I do not suggest for one moment letting them see a typed note of your injuries etc. If you can type that, then you are playing into their hands.
good luck
0

#4 User is offline   Alan Thomas 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 10801
  • Joined: 10-June 06

Posted 26 May 2009 - 12:41 PM

Does anybody know what the criteria is for occupational assessment?

Obviously there is a criteria and obviously information must fit into the criteria.

Where can we get this information?
0

#5 User is offline   Shapeshifters 

  • Newbie
  • Pip
  • Group: Members
  • Posts: 5
  • Joined: 11-February 08

Posted 26 May 2009 - 01:16 PM

Jack Posted Today, 12:55 AM
hi
have IOA coming , and have 3 people in the Manawutu to pick from

1) Kelly Retter - Adapt Therapy Serices

2) Doug Pitcher - Career Essentails

3) Tony Vincent - Human Capital Development

any info on these people would be most helpful

thanks
Jack

Hi Jack, I may be able to help with info regarding one of the aboved named

PM I need to be sure that I have the right person first

Cheers S/S :unsure:
0

#6 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 02:08 PM

View PostFighter for Justice, on May 26 2009, 07:18 AM, said:

Jack, I know nothing about any of these Assessors.

But, having recently been put through Initial Occupational Assessment I suggest checking the following: Does IOA Referral have correct job description, mention all covered injuries, have the correct pre-incapacity earnings figure. The IOA Referral should also mention what information ACC gave the IOA e.g. IRP, prior IOA/IMA etc.
Attached should be a Documentation Sheet: mentioning ALL information given by ACC to Assessor.

Suggest you take all reports which you believe are helpful, type a letter mentioning anything you believe ACC have failed to mention to IOA e.g. require all covered injuries included, correct job description, correct pre-incapacity earnings. Mention your comments regarding previous reports (which ACC given to IOA e.g. previous IOA/IMA Reports, IRP (Deemed or Signed)). I would also put in writing what you believe you want from ACC re Vocational Rehabilitation e.g. what course, tertiary study, help with small business etc and WHY you believe it is cost effective for ACC to provide you with this - (rather than 2 weeks computer training ACC style).

Get Assessor to sign your copy of the typed letter (so they cannot say they never received it)!
Take a witness and a audiotape to IOA - then you have a record of what was said!
I say this as I believe some IOA tape these interviews anyway!

Good luck!



Put it in writing with your option to any realistic rehabilitation You go with nothing and the Assessor will think that you are a bludger, and write a report implying that all that you want to do is to sit around all day and live off the ACC as it is higher than the unemployment benefit.

Your IRP, IOA, IMA and work trail/capacity assessment, fraud investigation are all part of a process to gather that type of information.

View PostSparrow, on May 26 2009, 12:16 PM, said:

Jack, the most important of all is to obtain, BEFORE you go, all the report copies that ACC will be sending to the IOA assessor.
Then you will know what has been deliberately left out.

When you go to Assessment make sure that they do not start mentioning any jobs that are beyond your physical capabilities and training.
I do not suggest for one moment letting them see a typed note of your injuries etc. If you can type that, then you are playing into their hands.
good luck


Forget the physical capabilities of a job, but if there is any training needed tell them. If the assessor doesn't list the job option in the report complain. The more stupid jobs that they give you the worse the report will look.

Remember to take the documentation along in writing preferable with an option to gain employment in anything or maintain employment into which you are now employed.
0

#7 User is offline   Sparrow 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 534
  • Joined: 22-March 07

Posted 26 May 2009 - 04:23 PM

Dopel, you are WRONG WRONG WRONG.
Shonky advice as usual.
0

#8 User is offline   marypoppins 

  • Newbie
  • Pip
  • Group: Members
  • Posts: 2
  • Joined: 22-April 06

Posted 26 May 2009 - 04:23 PM

Avoid Kelly Retter at all costs.I was assessed by her some years ago. Despite a shoulder injury she stated I would be able to be a mail sorter, horticultal nursery worker & with basic office experience that I could be a Human resources manager & aduitor.When I pointed out to her that I didnt have those skills or anything close to it I was ignored.Her and her sister are on the Acc gravy train so to speak.
0

#9 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 04:33 PM

View PostSparrow, on May 26 2009, 04:23 PM, said:

Dopel, you are WRONG WRONG WRONG.
Shonky advice as usual.


try reading some of the policies.

About rehabilitation
Definition of rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Rehabilitation is the means or process of active change, by which a claimant regains or
acquires, and uses the skills they need for their optimal physical, mental, vocational
and social function, considering their injury.
We approach rehabilitation on a functional basis, focussing on outcomes.
According to Section 13, rehabilitation means providing assistance to a person who's
suffered a personal injury, with the aim of:
• Helping them regain or use the skills necessary for the degree of mental,
physical, social, and vocational function.
• Enabling them to lead as normal a life as possible, considering the consequences
of the injury.
Aims of rehabilitation
Rehabilitation outcomes focus on the claimant's:
• Impairment:
It aims to return the body part to its pre-Injury state.
• Activities:
It aims to minimise the injury-related limitations, allowing them to return to
their pre-injury activities.
• Participation:
It aims to reduce injury-related barriers, allowing the claimant to participate in
the community.
Types of rehabilitation
The three areas of rehabilitation are:
• Social rehabilitation
• Vocational rehabilitation
• Medical rehabilitation, or treatment (including physical and mental).
We manage these three areas of rehabilitation concurrently, within an individual IRP.
Definition of managed rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under preVious acts.
Managed rehabilitation is the process, system or approach that Ace uses to achieve the
following goals:
• Achieve durable rehabilitation outcomes.
• Contain costs.
• Ensure claimants achieve the rehabilitation outcome in a specific timeframe, and
within legislative requlrernents.
This system, and the methods and tools that support it, can also provide ACC with
detailed information about claimant reserving.
(Claimant reserving is the practice of projecting the costs of rehabilitating the claimant,
based on their type of injury. This means that we can reserve funds, sufficient for
managing claims into the future.)
Managed rehabilitation focuses on the following questions:
• What outcome can we expect the claimant to achieve, so that we can consider
their rehabilitation complete?
• What does the claimant need, in order to be able to achieve that outcome?
• What options do we have, for ways to meet those identified needs?
Once we have determined the answers to these questions, we can identify the
specific interventions we will provide.
Use of discretion
The rehabilitation process defines how you need to deal with the claim. However, each
claimant's injury and circumstances are unique, and this affects what will lead to them
achlevinq their rehabilitation outcome.
So, the process necessarily has to allow you to use your discretion in deciding exactly
what interventions to provide. You must follow the process to arrive at your decision,
but the decision itself depends on what is most appropriate in the circumstances.
Principles of managed rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
~1anaged rehabilitation is governed by these principles:
• We deliver rehabilitation interventions based on a defined process. This provides
a consistent approach, yet allows flexibility and creativity in achieving durable
outcomes.
• We provide all contact groups (employer, GP, claimant, rehabilitation provider)
with standardised information about expectations and timeframes for outcomes,
from the Duration Tables and Treatment Profiles.
• We manage delivery of rehabilitation interventions within the projected costs,
and within the standards for quality, duration and accuracy.
• We plan and implement all aspects of rehabilitation so they are integrated and
occur concurrently.
• We apply legislation so that it rehabilitates the claimant to a state of workreadiness
or independence, not necessarily a permanent job.
• Claimants are responsible for participating fully in their own rehabilitation. We
are responsible for ensuring claimants understand their rights and
responsibilities. It is crucial that claimants actively participate in planning,
making decisions and developing the IRP.
• We focus on proactive, up-front management of claims, to reduce claimants'
time on the scheme. Immediate or early intervention can protect employability,
reduce lost work time and control costs to the claimant, to the employer, and to
us.
• Time-framed rehabilitation outcomes drive the rehabilitation process where there
is a pre-determined end-point.
• Our rehabilitation decisions are sufficiently robust to be legally defensible.
• Separating assessment services from provision of rehabilitation services avoids
conflict of interest, and over-servicing by providers.
• We manage rehabilitation service providers' performance through purchasing
time-framed outcomes, using standardised contracts and service specifications.
• Regular, active Quality Assurance practices ensures that we practice all aspects
of managed rehabilitation with benefits for us, insurers, claimants, employers,
and providers.
About the "front end" of case management
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The "front end" process involves the early case management tasks you carry out when:
• A claim arrives in the branch, after having been either:
• Streamed there by the electronic streaming tool, following registration.
• Transferred there by a contact centre because a risk assessment indicates
the claim needs closer case management.
• A claimant approaches the branch for assistance
Note:
Contact centres also carry out front end activities, using procedures similar to
branches'.
The full "front end" process in Informe
The full "front end" process involves all of the procedures you carry out, when you first
establish the case management of a new claim. The "front end" includes the following
activities, as described in the relevant documents in this folder of Informe:
• Checking the claim details.
• Gathering and considering information from the claimant, and their GP and
employer
• Confirming cover
• Making a preliminary check about the claimant's needs, and the likely assistance
we can provide them
• Assessing the claim risk
• Costing the claim
These initial stages lead into the detailed rehabilitation and case management process,
of setting the rehabilitation outcomes, assessing needs, deciding and implementing
assistance, and so on.
Note:
You'll find you need to repeat these activities periodically during your management of
the claim. However it is crucial to make a full, accurate assessment and cover decision
in the first instance, at the front end.
Key concept: Risk
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The level of risk of a claim is the likelihood that it will take longer than we expect for
the claimant to achieve their outcome, and therefore the claim will cost more than we
expect, for an injury of that particular type.
Our expectations about claim duration are set by:
• The standard durations from the MDA database (as described with the
rehabilitation tools) for the type of injury the claimant's suffered.
• Individual risk factors for the particular claimant, that can shorten or lengthen
the standard durations, such as their age, the severity of the injury, any
complicating infections, their type of work, and so on.
• The availability of alternative duties from the claimant's employer (which usually
shortens the duration).
We assess the risk level of a claim at these times:
• Electronically (via the streaming tool), as soon as the claim is registered, to
determine where the claim should be streamed for management.
• Manually (via the risk assessment checklist), once it arrives at the managing
unit, after streaming, to make sure the electronic streaming has put it in the
right place.
• Manually (via the risk assessment checklist), at any time when a risk alarm or
trigger is raised, to check whether it needs to be transferred to another unit for
more appropriate management.
The purpose of keeping a close eye on the risk level of a claim is to ensure we manage
the claim appropriately. This means we can make sure the claimant receives all the
assistance they need and are entitled to, so they can achieve their rehabilitation in the
shortest possible duration.
Note:
The focus of assessing a claim's risk is on determining how difficult it will be for the
claimant to return to work or independence, which can impact on:
• How long it will take them to achieve their rehabilitation outcome, and therefore
• How much the claim will cost.
See Assessing risk for more details.
Key concept: Individual rehabilitation plan (IRP) and
case intervention strategy (CIS)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
IRP
The IRP is the record of the rehabilitation process for a claim.
It's first established when you determine the indicative rehabilitation outcome. It's a
working document, that's updated and built on, as you plan the interventions in detail
with the claimant. You change and add to the IRP as your implement and monitor the
interventions through the rehabilitation process. The claimant signs their agreement to
the IRP when it's first established, and whenever it's updated.
The IRP can have various attachments, such as a vocational assessment,
return-to-work programme, CIS, and so on.
See IRP for full details.
CIS
The CIS is a simple management plan that outlines the interventions the claimant
needs, to return to work or independence. It's provided as a tab in Pathway.
It is used by contact centres (mainly) for all claims where the claimant needs time off
work or social rehabilitation assistance. A CIS doesn't have to be signed by the
claimant, so it doesn't meet the legislative requirements for an IRP.
The CIS can be used as an attachment to the IRP.
When to use IRP and CIS
As a general qulde:
• Branches normally use the IRP.
• Contact centres normally use the CIS.
Case managers in branches should only use a CIS in these situations:
• The claim is streamed to the branch as high risk, but when assessing risk with
the RAC, the further information indicates the claim is in fact low risk.
• The claimant approaches the branch for assistance, for a claim that would have
been streamed to the contact centre as low risk. The claim is managed in the
branch though the risk assessment shows it's a low risk claim.
However, even if you begin managing the claim with a CIS, always escalate that to a
full IRP if you find that either:
• The claimant is likely to need ACC assistance for longer than 13 weeks.
• The claimant scores medium or high risk on the RAC.
You'd probably discover this while monitoring and evaluating the claim, as described in
the Rehabilitation process.
Key concept: Claimant's responsibilities
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
According to Schedule 1, Clause 28\ a person who's covered for a personal injury is
responsible for their own rehabilitation as much as the injury allows. However, under
the Act, they're also entitled to rehabilitation that will let them lead as normal a life as
possible, considering the consequences of the injury.
This is a key issue, as the claimant needs to be involved at every step of their
rehabilitation. They need to agree to the activities in the IRP, and they need to
understand that they have to participate and take responsibility for their part in
carrying out those plans.
Observe the quldellnes about claimants' legislative rights and responsibilities.
You should use the fact sheet for IRP preparation to:
• Inform the claimant of their rights and responsibilities, when you start preparing
the IRP.
• Clarify these points, whenever that's needed.
Key concept: Defensible decision-making
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1 "Insured's and insurer's obligations in relation to rehabilitation"
All decisions you make about a claimant's rehabilitation need to be sufficiently robust to
be legally defensible.
There are tools" to use, to test your decision-making.
This means you need to be able to prove that you've:
• Applied the legislation correctly.
• Applied the documented policy correctly.
• Followed the documented process.
• Used the tools appropriately.
• Taken full account of the claimant's individual needs and circumstances.
Getting the claimant's signature on each update to the IRP is a key part of this proof.
It's also crucial to document all:
• Discussions
• Decisions
• Activities
• Matters considered to reach decisions
If you use the procedures and information in Informe, all your decisions should meet
these requirements.
Why it's important
Defensible decision-making is vital to protect ACC from legal action, if the claimant
considers they have not received what they believe they're entitled to.
As an important side effect, this approach also protects ACC from wasted cost, incurred
because we provide a claimant with:
• More interventions than they should be entitled to.
• Interventions that are ineffective, or that actually interfere with their recovery.
Key concept: Intervention
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
An intervention is a specific way we assist the claimant. An intervention can be almost
anything, depending on the claimant's needs. The intervention is focused specifically
on meeting an identified need, to help achieve the rehabilitation outcome.
When you decide the details of an intervention, you need to make sure it is costed, and
is "SMART". That is:
• Specific
• Measurable
• Achievable
• Realistic
• 7lmeframed.
2 These are detailed fully with the rehabilitation tools information.
We can provide interventions in each rehabilitation area:
• Social interventions
• Vocational interventions
• Medical interventions (treatment).
Interventions are also referred to as services, support, care, contributions, assistance or
entitlements". Interventions can be any or all of these things. Common types of
intervention are:
• An assessment (such as a medical assessment, or a vocational assessment).
• Assistance by a rehabilitative service provider (such as a speech-language
therapist).
• A service by a general service provider (such as taxi services).
• Physical objects (such as a hearing aid, or an access ramp to the claimant's
home).
• Training in a particular area (such as how to work safely with an ongoing
impairment).
What any particular claimant will receive depends on their particular assessed needs,
and individual circumstances. Interventions are detailed in full under the various
entitlements in Informe.
Quality standards
All interventions provided need to:
• Bejmplemented concurrently, and as soon as possible.
• Directly address the identified needs.
• Directly support the rehabilitation outcome.
• Be of the required quality.
• Be likely to achieve their purpose (to address the specific need), with durable
results.
• Be cost effective.
• Be appropriate in the circumstances.
• Be provided only for the minimum time strictly needed to achieve the outcome.
Key concept: Duration management
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Duration management is an approach to rehabilitation, to regulate the time we spend
rehabilitating a claimant. The aim is to keep the time to a minimum, while still meeting
the relevant quality standards, and achieving durable outcomes.
It involves setting a timeframe at the start of the rehabilitation process, within which
the claimant should be able to recover from their particular type (or types) of injury.
Recording this information also allows us to monitor how well we are achieving the
duration targets we set.
3 Interventions are provided under particular entitlements. For example, Aids and
Appliances is an entitlement; a hearing aid is an intervention.
There are tools provided, which you use to support your duration management
actlvltles",
Key concept: Rehabilitation outcome
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The rehabilitation outcome? is a statement of the agreed aim of the overall
rehabilitation. Outcomes have a specific timeframe, by which we aim to achieve them.
The rehabilitation outcome is the focus point of all the interventions and other
rehabilitation activities. It is a statement of the target point, indicating when you can
consider the claimant's rehabilitation to be complete.
Outcomes have to relate to the claimant's individual, everyday, "real world" activities
and behaviour.

About types of rehabilitation, outcomes and
entitlements
Social rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
According to Schedule 1, Clause 38, the purpose of social rehabilitation is to help a
person to carry out the "activities of daily living" as independently as possible,
considering the impact of their injury.
The outcome for social rehabilitation is to "regain independence in everyday activities".
Social rehabilitation was previously known as "Support for Independence".
Definition of activities of daily living
Schedule 1, Clause 36, describes activities of daily living as:
• Financial management
• Health care
• Home management
• Hygiene care
• Meal preparation
• Mobility
• Safety management
• Shopping
• Use of transport
• Retraining for driver's licence (if held prior to injury)
• Training for a person needing aids and appliances in their use and maintenance
Quality standards
Social rehabilitation interventions must meet these criteria:
• An assessment specifies they need that intervention.
• The intervention will help them carry out daily living activities as independently
as possible, considering the injury.
• The intervention is necessary, appropriate and of the required quality, to help
them carry out their daily living activities as independently as possible.
• If it's decided an Individual Rehabilitation Plan (IRP)l is needed, the
interventions are agreed in the plan.
• If there are legislative requirements for the entitlement to a particular type of
Intervention", these are met.
Social rehabilitation outcome
This information relates to ACC's application of the AI Act 1998 and other previous
1 As described in Schedule 1, Clause 13
2 As described in Sections 42 to 52
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The standard outcome for social rehabilitation is to "regain independence in everyday
activities".
Schedule 1, Clause 33, defines this outcome.
Many claimants will have this as an outcome, whether or not they also have one of the
vocational outcomes.
This could be the claimant's only outcome, if:
• The claimant was not capable of work prior to the injury (such as a child, invalid
or elderly person).
• Their injury is expected to render them permanently unfit for work (such as a
tetraplegic condition).
General aim
The general aim of this outcome is to restore the claimant's independence in their
day-to-day life to either:
• Their pre-injury level.
• If that's not achievable, the optimum level their injury allows.
Suitable claimants
This outcome is suitable for all claimants whose injury disables them (short or long
term) in any of their normal everyday living activities.
Social rehabilitation entitlements
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
We can provide social rehabilitation interventions under the following entitlements:
• Aids and appliances (including hearing aids, and other augmented
communication devices)
• Medical consumables (such as continence care disposables)
• Education support
• Modifications to the home
• Transport for independence
• Personal care (including attendant care, child care, home help and relief care)
• Training for independent living (TIL)
• Any other interventions covered by Section 403
•
Vocational rehabilitation and outcomes
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
3 "Cover for mental injury caused by certain criminal acts"
We can provide vocational rehabilitation interventions to a claimant who has cover for.a
personal injury and is:
• Entitled to weekly compensation; or
• Likely to be entitled to weekly compensation if vocational rehabilitation is not
provided; or
• On parental leave".
Vocational outcomes
According to Schedule 1, Clause 54, the purpose of vocational rehabilitation is to help
the claimant to:
• Maintain current employment; or
• Obtain employment; or
• Acquire a capacity for work.
This means you have to identify one of these three aims as the claimant's vocational
rehabilitation outcome.
About vocational interventions
When you're deciding on a vocational intervention, you need to consider (and document
your considerations on) whether it's:
• Likely to achieve its purpose.
• Likely to be cost effective. (That is, entitlement costs should reduce as a result.)
• Appropriate for the claimant's circumstances.
• Provided for the minimum period needed to achieve its purpose. (Maximum is
3 years.)
When social rehabilitation also required
If the claimant also needs social rehabilitation, the vocational outcome is the primary
one. You provide any social rehabilitation interventions that will support the vocational
outcome, concurrently with the vocational interventions. If the claimant achieves the
vocational outcome, and still needs social rehabilitation, you then set the social
rehabilitation outcome as the primary outcome.
Vocational rehabilitation strategies
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
You need to base your decision, about which rehabilitation outcome you select, on the
folloWing hierarchy of considerations (as described in Schedule 1, Clause 555
) .
Same job,
same employer
Or if that isn't possible ...
Different job,
same employer
Maintain employment
Maintain employment
4 Parental Leave & Employment Protection Act 1987
5 "Hierarchy of considerations"
Or if that isn't possible ...
Same job,
different employer
Or if that isn't possible ...
Different job,
different employer
Or if that isn't possible ...
provide appropriate rehabilitation to
help the person use their pre-injury
skills to obtain employment
Obtain employment
Obtain employment
Obtain employment; or Regain an
ability to work
Outcome: Maintain employment with same employer
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Schedule 1, Clause 54 defines this outcome, which has also been known as
"employment maintenance".
General aim
The general aim of this outcome is to restore the claimant's capacity to continue
working with their current employer (whether in the same specific job, or a different
one).
By preference, rehabilitation under this outcome aims to:
• Make sure the claimant maintains their existing job.
• Return them to their pre-injury level of work activity, both in the type of tasks
and the number of hours they work.
If the claimant is unlikely to return to their pre-injury level of work activity, then the
next preference is to consider appropriate alternative jobs with the same employer.
Suitable claimants
This outcome is suitable for claimants:
• Who have a suitable job they can return to.
• Whose employer is willing to hold their pre-injury job available for them, or to
provide alternative suitable work.
• Who'll be able to return to the number of hours they worked before the injury
(or can build up to that), within a specified timeframe.
Suitable interventions
To help the claimant achieve this outcome, consider the following interventions.
• Reducing the claimant's hours of work, then gradually returning them to the
hours they worked before the injury.
• Making modifications to their workplace.
• Modifying their duties (the tasks they perform).
Note:
Remember that interventions need to be provided concurrently, wherever possible.
Outcome: Obtain employment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Schedule 1, Clause 54, defines this outcome, which is aimed at helping a claimant
secure employment. That can be with a different employer from their pre-injury work.
It can be employment that's either:
• Similar to their pre-injury employment.
• Suitable for their pre-injury experience, education, training, and injury status.
Working toward this outcome includes the claimant making a reasonable effort to
actually obtain a job.
General aim
The general aim of this outcome is to restore the claimant's ability to work in either:
• The same type of job, for a different employer.
• A different type of job, for a different employer.
Suitable claimants
This outcome is suitable for claimants who have lost their pre-injury job, and all of the
following apply:
• They're highly motivated to work.
• They'll be able to do 30 hours work or more a week (or can build up to that).
• They have sought-after skills, education, or experience.
Suitable interventions
To help the claimant achieve this outcome, consider providing the followlnq
interventions.
• Vocational assessrnent.twtth CV preparation.
\) • Functional Capacity Evaluation (FCE).
/
• Short training course.
Notes:
• Any gradual return to full work hours has to be within a specified timeframe.
• Remember that interventions need to be provided concurrently, wherever
possible.
• Only propose specific alternative employment roles for the claimant, if they can
achieve the outcome within the specified timeframe, and their treating medical
practitioner agrees.
Outcome: Regain an ability to work
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Schedule 1, Clause 54, defines this outcome.
We provide rehabilitation under this outcome to make sure we meet our responsibilities
to provide the support and training the claimant needs to be able to seek and undertake
appropriate work. This outcome was previously known as "acquire a capacity for work"
or "work readiness", and various combinations of these phrases.
Only a limited range of interventions is available to claimants with this outcome.
General aim
The general aim of this outcome is to remove any obstacles that prevent the claimant
from havlnq the capacity to work in any job that they have skills, education or
experience for.
Suitable claimants
This outcome is suitable for claimants who:
• Have already received vocational rehabilitation, under one of the other
outcomes, which wasn't achieved.
• Can't return to their pre-injury job
• Can't work in specific types of job for 30 hours a week or more
• Have suitable education, experience or training to work in other jobs
• Aren't likely to obtain suitable alternative work within a reasonable period.
Suitable interventions
To help the claimant achieve this outcome, consider the provldlnq follOWing
interventions.
• Vocational assessment, with CV preparation
• Pre-employment preparation
o Word-ready programme (provided by a contracted provider, including work
trials)
• Short training course.
Note:
Remember to provide interventions concurrently, if possible.
WRAP on expected outcome date
Once all the planned interventions have been completed, you arrange a referral for
WRAP, to confirm the claimant's readiness for work. This allows us to confirm whether
the claimant has achieved the outcome.
Vocational rehabilitation entitlements
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
We can provide vocational rehabilitation interventions under the followlnq entitlements:
• CV preparation
• Functional Capacity Evaluation (FCE)
• Pre-employment preparation
• Return-to-Work (RTW) programme
• Self-employment
• Short training course
• Vocational assessment
• Workplace assessment
• Work-ready programme
Note:
The particular outcome for any claimant determines which entitlements are available to
them, as described earlier under each vocational rehabilitation outcome.

Don't forget to transfer this over from the 98 Act to the current Act.
0

#10 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 04:42 PM

and more

Medical rehabilitation (treatment)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
According to Schedule 1, Clause 26
, the purpose of providing treatment is to enable the
claimant to lead as normal life as possible, considering the consequences of their injury.
The specific treatment that is appropriate for any particular claimant depends on their
particular injury or condition. It must be planned in consultation with the claimant's
GP.
Medical rehabilitation must be:
• Necessary.
• Appropriate.
• Of the quality required for the purpose
• Carried out only as frequently, or for only as long, as necessary to achieve the
outcome.
• Provided at the appropriate time.
• A treatment normally provided by treatment providers.
• Provided by the type of treatment provider who usually provides this type of
treatment.
Authorising treatment for rehabilitation
When you are deciding whether to authorise treatment for rehabilitation, consider:
• The nature and severity of the injury.
• The means generally accepted in NZ for treating this injury.
• The other options for the treatment, available in NZ.
• The costs of both the generally accepted treatment and the other options,
compared to the benefits the injured person is likely to receive.
Notes:
• The insurer can require that they give approval, prior to providing non-acute
treatment or interventions.
• We can restrict the amounts payable for some specified treatments.
• The costs of interventions related to providing treatment are also payable, such
as accommodation, nursing, transport, and emergency transport provided by a
qualified operator. (This includes return journeys to the claimant's home, after
acute or elective inpatient treatment - if they're eligible for non-emergency
return journey costs.) See the treatment procedures for more information.
6 "Employer must pay"
Back injuries - special requirements
Special requirements for back injury claims
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Back injury claims tend to be the largest single group of claims. In addition, a large
number of back injury claims tend to be high-risk.
If a back injury only involves soft tissue damage, and there's no indication of nerve
damage, it's a well-accepted approach to encourage the injured person to remain
active, rather than avoiding activity.
How to manage back injury claims
For back injuries, follow the same procedures as for other rehabilitation cases, and
observe the same timeframes and principles. Plus, for back injuries, there are some
additional procedure steps to carry out.
The procedures where this is relevant are as follows:
• You need to gather additional information when you're first allocated the claim.
• You need to ask the claimant to complete some additional forms, when you meet
with them to discuss and set the rehabilitation outcome.
• In all stages of the IRP, you need to focus more strongly on effective
communication with, and involvement of the claimant's employer and GP.
SUPPQrt information about back injuries
The following resources are useful tools for identifying and managing likely problems
with back injuries:
• New Zealand Acute Low Back Pain Guide -1999 Edition
• Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain
Overview chart
Overview chart of the rehabilitation process
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
r--,
I I
I I
I Front- I
I end I
I I
I I
I I
Outcome
not achieved
outcome
achieved
1 Check claim
About checking claims
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The first step of the "front end" of case management, once a claim is received at the
managing site after streaming, is to check the claim information you've received.
This stage of the front end process gives you the opportunity to develop an initial idea
of the type of claim, so you can start the front end process from "the right foot".
This applies, no matter whether you're receiving the claim at the branch, or at a
specialist unit such as:
• Low risk unit at a contact centre
• Employer unit at a contact centre
• Medical misadventure unit
• Sensitive claims unit, and so on
Note:
Documentation for the various specialist units give them specific procedures for
checking claims, that are relevant to the particular types of claims they deal with.
Who transfers the claim to you
Once registration centre staff have recorded all the information in Pathway from the
ACC45, including the injury's cause, they process it through the risk streaming tool, and
then transfer the claim to the identified managing site. (They can't transfer the claim
unless they've recorded all the ACC45's information.) The ACC45 isn't sent to the
branch.
Note:
If the streaming tool identifies no risk for the claim, the claim is registered, kept at the
service centre, and closed. These claims are only transferred to the branch if
specifically requested (for instance, if the claimant presents themselves at the branch).
In these cases the ACC45 is sent to the branch, because the claim wasn't fully
registered.
Receiving claim transfers
All claim transfers happen electronically. The team manager assigns a branch team
member to check the mailbox regularly.
The team manager oversees allocation of the claim to appropriate management, to
make sure that the claimant is contacted within 48 hours of the claim arriving in the
branch.
Note:
These details are currently being reviewed and will be updated when changes are
confirmed.
Claims transferred from contact centre, low risk unit
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The low risk team in Contact Centres will transfer a small percentage of claims in their
early stages, after they've completed the risk assessment checklist (RAe).
They'll do this if the risk assessment reveals the claim is:
• High or medium risk, or
• The claim fits the criteria for transfer to a branch.
They can also transfer a claim during its ongoing management, if:
• A trigger or alarm is raised, or
• For some other reason, the claim has escalated to high risk.
(See the document in Informe on monitoring claims for more details.)
Before the Contact Centre makes the transfer, they're required to contact you (or your
team manager) to discuss the transfer. Their instructions are to make sure they never
"surprise" branch staff with unexpected claim transfers.
Agreements between branches and contact centres will be set up shortly, which will
outline the requirements to make sure claim payments are up-to-date and accurate,
and claims are fully documented before hand-over.
Claims referred from contact centre, employer unit
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Case manager completes these tasks when the employer unit at the Contact Centre
refers a claim to the branch for case management.
In this situation, the claim isn't transferred to the branch. The case co-ordinator
requests the branch case manager to provide case management services for the claim,
but the case co-ordinator retains overall management responsibility for the claim.
By the time the request arrives at the branch for case management, the case
co-ordinator should already have completed the front end activities. The branch case
manager is considered the "secondary" manager.
Note:
Service level agreements are being established between branches and contact centres,
which will govern this process.
Case manager responsibilities
The case manager:
• Provides professional case management services. Depending on the contents of
the referral from the case co-ordinator, this is likely to include:
• Completing the IRP.
• Carrying out all rehabilitation activities to return the claimant to work or
independence.
• If applicable, works with the employer locally, to achieve the claimant's return to
work.
• Keeps the case co-ordinator informed about progress.
Case co-ordinator responsibilities
The case co-ordinator:
• Retains oversight of the case, so that they can give the employer a complete
picture of all claims.
• Monitors case management progress.
If claimant approaches branch for assistance
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Although claims are allocated and sent to the appropriate managing site, we still expect
some claimants to present themselves to their nearest local branch for assistance.
This could occur in cases like these:
• No time off work or assistance required was indicated on the ACC45 form. The
claim consequently was closed.
• The treating practitioner advised the claimant to visit the branch.
• The claimant had a recurrence or re-aggravation of an old injury, and presents a
medical certificate to the branch. (The streaming tool doesn't take medical
certificates into account.)
• The claimant hadn't been contacted by anybody at ACC.
Although we can't prevent this happening altogether, we aim to minimise it, by
contacting the claimant within 48 hours of receiving the claim - and preferably on the
same day - if we deem the claim needs case management.
It will take a little longer for treatment providers to change their practice, although we
have advised them about the new claims streaming process.
Note:
Even if the branch provides case management for a work injury claim in a situation like
this, the employer unit at the contact centre still "owns" the claim.
How to respond to claimant
Use the procedures later in this document to respond to a claimant who approaches the
branch for assistance
There is a checklist available at the branch called "Claimant approaches branch - Action
checklist". Always use this sheet to make sure you cover all the steps and respond
correctly to the claimant's contact.
Procedure: Check claim received from registration
centre
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The case manager completes this procedure, within 48 hours of receiving the claim from
the registration centre.
1. Research the current information on the file, particularly:
• Accident details
• Treatment plan, and the expected duration of incapacity for the type of injury
• Claims history
2. Consider whether that information is consistent with:
• GP's certification of treatment
• SerVices required
• Fitness for work
3. Determine the following information:
• Expected injury duration (from the MDA Tables).
• Expected treatments (from the Treatment Profiles).
4. Establish whether there are any medical complications or other risk factors
indicated, that are likely to prolong the claimant's recovery. (This is just a
preliminary check: you'll confirm risk factors later.)
5. Carry out the following procedures:
• Gather information (including confirming cover).
• Assess risk (including claim costing).
Procedure: Check claim received from contact centre
low risk unit
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The case manager completes this procedure within 48 hours of receiving the claim
transferred from the Contact Centre.
Note:
You should always have advance warning of these claims being transferred.
1. Check the following injury details:
• Treatment plan and expected incapacity for type of injury
• Claims history
• ActiVity notes, and the reason for transfer from the Contact Centre
• Results of the Contact Centre's risk assessment on the RAC tab in Pathway (if
completed)
• Case intervention strategy details on the CIS tab in Pathway (if completed)
2. Identify whether pain is an issue. If it is, have form ACC278 or ACC2811 ready for
the claimant to complete when you interview them (as described in Gather
information).
3. Arrange an interview and meet with the claimant, to confirm the Contact Centre's
assessment details.
Notes:
• Advise the claimant they can bring a support person with them, if they wish.
• Always follow WorkSAFE procedures when meeting with claimants, and record
you've done this.
4. Complete the remaining steps of the front-end procedure for receiving claims from
the registration centre.

Procedure: Check claim (claimant approaches branch)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1 Pain questionnaire - earner, or Pain questionnaire - non-earner
Case managers use this procedure to respond to a claimant who presents themselves to
the branch for assistance, and their claim is for either:
• A non-work injury.
• A work injury to a self-employed person who hasn't purchased CoverPlus Extra.
(We manage these claims as if they were a non-work injury.)
1. Use your copy of the "Claimant approaches branch - Action checklist" to guide you
through this procedure.
2. Check whether you should be using the procedure later in this document for
referring a work injury claim to the employer unit:
• If yes, carry out that procedure instead.
• If no, continue this procedure.
3. Check in the system whether the claim is registered, and if so, where it is currently
managed.
4. If the claim isn't a work injury, and isn't registered:
• Fax the claimant's copy of the ACC45 to the registration centre to register the
claim.
• Keep the claimant's file at the branch, regardless of the risk (that is, don't
transfer it to the contact centre).
• Complete the procedure for front end tasks as if the claim had been received
from the registration centre.
Note: The original ACC45 isn't forwarded to the branch.
5. If the claim is registered, and is currently closed at the Registration Centre:
• Request the claim from the registration centre.
• Keep the claimant's file at the branch regardless of the risk (as for unregistered
claims).
• Begin managing the claim (as for unregistered claims).
Note: The original ACC45 is forwarded to the branch.
6. If claim is registered, and is currently at a Contact Centre, and they haven't yet
contacted the claimant:
• Request the claim from the Contact Centre.
• Keep the claimant's file at the branch (as for unregistered claims).
• Begin managing the claim (as for unregistered claims).
7. If claim is registered, and is currently at a Contact Centre, and they have previously
contacted the claimant:
• Assess the reason for the claimant making contact.
• If you can help with the claimant's query, provide the relevant assistance (for
example, accept medical certificate or receipts for reimbursement, and send
those to the Contact Centre, and tell the claimant you're sending them).
• Assess whether face-to-face case management is necessary. If yes, discuss with
the case co-ordinator, request the file from the Contact Centre, and manage as
for unregistered claims.
If the claimant requests face-to-face case management, and it's not a work injury,
get the claim transferred to the branch.
Procedure: Refer work injury claim to employer unit
(claimant approaches branch)
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Case managers use this procedure to respond to a claimant who presents themselves to
the branch for assistance with a work injury. (If this isn't a work injury claim, use the
procedure for other claims, earlier in this document.)
1. Use your copy of the "Claimant approaches branch - Action checklist" to qulde you
through this procedure.
2. Assess what assistance or information the claimant needs.
3. Check in the system whether the claim is registered and, if so, who's currently
managing it.
4. If the claim hasn't been registered, or you can't determine who the assigned case
co-ordinator is, check who the claimant works for.
Then check the employer tab in Pathway to see if the employer has a designated
case co-ordinator, and if so, what their contact details are.
5. Give the claimant an employer pack, and tell them:
• That the employer unit will manage their claim.
• If you know, who their case co-ordinator is likely to be.
• That the case co-ordinator will be contacting them.
• The employer unit's phone number.
Make available a phone for them, if they wish to immediately ring the unit.
6. Accept any documentation they provide (such as medical certificate, medical
receipts), and advise the claimant you'll send the documents to the employer unit.
7. Provide the claimant with all the relevant forms and documentation to complete,
and details of where to send them. (Provide a stamped, self-addressed envelope.)
8. If the claim was closed in the registration centre, the claimant requires assistance,
and there's no documentation to send to the employer unit, contact the employer
unit and advise them to contact the claimant.
9. Document all conversations on the Activities screen in Pathway.
10. Fax any documentation to the employer unit, and follow up with the original copies
in the post.
2 Gather information
About gathering information
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Gathering information, particularly the initial interview with the claimant, is a key point
in the case management process. It's an important opportunity for the case manager to
pave the way for the rest of the process to operate smoothly, and therefore for the
claimant to achieve their rehabilitation outcome quickly and effectively.
These objectives are important both:
• To ACC as an organisation, because it means we can be effective, efficient and
cost-efficient, and we can fulfil all our statutory obligations.
• To all the individuals involved in the process, because it means the claim can be
resolved with a minimum of effort, stress and waiting on everyone's part.:
The purpose of gathering information about a claim is to:
• Confirm cover
• Assess risk and identify barriers to independence
• Assess assistance required by the claimant
• Estimate cost of the claim
About the information gathering tools
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The tools available to assist you in gathering information are:
• Form ACC1201
• The checklists (later in this section) of suggested questions to ask the claimant,
their employer and GP.
These tools aren't intended to be rigid questionnaires, nor as a substitute for your own
skills, expertise and common sense. The aim of havlnq these tools is to:
• Promote consistency Within ACC of our initial claims assessments.
• Allow the claimant to tell their story only once, which avoids unnecessary
repeats of contact.
• Make sure all the relevant parties are invited to contribute relevant information
for planning a claimant's rehabilitation.
• Obtain comprehensive and accurate information as a basis for timely and
appropriate rehabilitation planning, based on the claimant's individual needs.
Notes:
• Don't ask the claimant questions directly from the text of the RAC tab in
Pathway (as described in Assess risk). Those questions aren't worded
appropriately for that.
• The pain questionnaires are a tool you might need to use during your
1 Claimant initial interview
information gathering (or soon after), but these are a risk screening tool, rather
than an information gathering tool.
Initial interview with claimant
Arranging the interview
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Contact the claimant to arrange an interview. (You can interview the claimant by
phone, if it's appropriate.) Make sure they receive a copy of fact sheet FSREB012 before
or during the interview.
If it's appropriate, involve the claimant's family or whanau to provide support. Make
sure the claimant knows they're welcome to involve support people as they wish.
Checklist
Cover the following points in the interview:
• Collect relevant social, family and medical information for use in decision-making
(as described in Obtain information from claimant).
• Explain how an IRP is prepared. Mention their right to have a representative
present with them, when you prepare or update, and sign the IRP.
• Manage the claimant's expectations. Provide advice on their likely entitlements,
the expected duration of their recovery, and the likely outcome.
• Seek their permission to contact their employer and GP, for their input to
developing the IRP.
• Advise them about their rights and responsibilities for their rehabilitation, and
ensure they understand this.
• (If you Wish) complete form ACC1203
•
• If the claimant has applied for (or likely will) for weekly compensation, get them
to complete form ACC1744
•
• If you identify pain is an issue, get them to complete form ACC2785 or ACC2816
•
• Set an appointment time to meet with the claimant again, to prepare and sign
the IRP.
Note:
Don't ask the claimant questions directly from the text of the RACtab in Pathway (as
described in Assess risk). Those questions aren't worded appropriately for that.
Obtaining information from claimant
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
2 Making a rehabilitation plan
3 Claimant initial interview
4 Declaration of responsibilities
5 Pain questionnaire - earner
6 Pain questionnaire - non-earner
The following questions give you some suggested phrases to use, to obtain the relevant
information from the claimant (or their family). Remember each situation is unique, so
you could need to ask other questions.
• Tell me more about your accident. (Check for cover issues: how, where, when,
what was injured. If relevant, verify whether the claimant is left or right
handed.)
• What treatment are you having? (Record name of treatment provider and GP;
ask permission to contact them. Check that claimant understands our injury and
recovery expectations.)
• How are you managing? (Explore areas such as work, house work, travel, family
responsibilities, unpaid responsibilities.)
• (If applicable) Who else is able to help? (Get details on their living situation,
access to support, children's ages, partner's availability, any organisations they
were involved with before the injury.)
• Do you have any other medical conditions or injuries? (Check for previous
injuries under a private insurer, whether they've been on ACC in the last 12
months, and whether they need any treatment for those.)
• (If applicable) Where do you work? (Confirm whether they're an employee,
self-employed, part time or full time, casual or permanent. Get employer
details, and ask permission to contact the employer. Record their number of
hours per week, and length of time in that employment.)
• What is the nature of your work? (Check whether it primarily involves standing,
sitting, lifting, driving, and so on.)
• What is preventing you from working at the moment? (Travel, pain, work
activities)
• What type of duties do you think you would be able to do?
• What does your employer think about the situation? (Check what contact they
have with their employer, any work issues, the employer's attitude toward ACC.)
• (If applicable) Are there any cultural or language issues I should be aware of?
Note:
Don't ask the claimant questions directly from the text of the RAC tab in Pathway (as
described in Assess risk). Those questions aren't worded appropriately for that.
About the ACC120 worksheet
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The ACC1207 is a worksheet designed to help you in the interview, as a reminder of all
the things you need to cover, and as a tool for recording what you discuss with the
claimant.
Using this sheet is recommended, but optional.
You can use it to gather information, for instance, when you meet with the claimant
away from your workstation, to take notes so that you can input all the details
accurately into Pathway after the interview.
Note:
The version of this worksheet was updated in Informe in February 2000. Please only
use this up-to-date version of the worksheet.
7 Claimant initial interview
About the ACC174 form
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant indicates during the initial interview, that they intend to apply for weekly
compensation, you need to:
• Give them a copy of the ACC1748 form.'
• Explain its contents and its impact.
• Obtain their signature on the form.
• File this in the claim file.
About the ACC174
The ACC174 form is critically important for weekly compensation. It lists the "rules"
that we require the claimant to comply with, if they are to receive weekly
compensation.
Keep in mind, however, by signing the form the claimant is not indicating they agree
.with these "rules", but that they:
• Confirm you've explained the rules to them.
• Acknowledge they understand the rules.
Note:
If any claimant is already receiving weekly compensation, but hasn't previously been
given this form to sign, they also need to sign one.
Impact of the form
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Having the claimant sign this form means they're aware of their responsibilities from
the outset. It also means that we can charge them a penalty if we overpay them
(which deters claimants from fraud). The following table shows the situations we tan
do this in, and what penalties we can apply.
If
Doesn't advise us if they gain work 10% of the overpaid amount.
while they're receiving weekly
compensation, or of any other matter
they ought to know is relevant
Makes a deliberately incorrect Three times the overpaid amount.
statement with the aim of collecting a
payment they're not entitled to
If the claimant won't sign
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant refuses to sign the form, we can't decline their eligibility for weekly
8 Declaration of responsibilities
compensation on this basis. However, if they refuse without a reasonable excuse, then
we can consider approving their entitlement, but decline to provide it under
Clause 116(3)9.
Pain questionnaires
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete the relevant pain questionnaire if the claimant is high risk, medium risk or
you identify that ongoing pain may be an issue.
For further information, see Pain questionnaires.
Discussion with claimant's employer
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant was employed at the time of the injury, contact their employer, to
gather their input for developing the IRP or Case Intervention Strategy (CIS), and for
you to complete the risk assessment using the RAC.
Checklist
Cover the following points:
• Confirm details about the type of work, and identify possibilities and issues for
the claimant's return to work (as described in Obtain information from
employer).
• Offer the employer advice on the benefits of work place rehabilitation, early
return to work, graduated return to pre-injury level of employment, and
alternative duties.
• Manage the employer's expectations.
• Encourage them to participate in the rehabilitation planning.
Extra requirements for back injuries
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant's suffered a back injury, while you're gathering information about the
claimant's employment, identify any opportunities for rehabilitation within the
workplace.
If it's not suitable to gather this information by phone, either:
• Visit the workplace and use form ACC28010 to obtain information about the
tasks, environment and rehabilitation opportunities. The "Return to workWorkplace
checklist for clients with back injuries" can be used.
• Send letter GP26 to an assessor, to arrange for a workplace assessor to obtain
the information from the workplace.
9 Insurer may suspend or decline to provide statutory entitlements
10 Return to workplace checklist
Refer to the advice to employers in the book "Active and Working! Managing Acute Low
back Pain in the Workplace"l1 and encourage the employer to complete the checklist on
page 18 of this booklet.

Obtaining information from employer
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The following questions give you some suggested phrases to use to obtain the relevant
information from the claimant's employer.
• What exactly does [claimant] do at work? (For example: if it involves lifting, how
often, what weights, how awkward; how long do they spend standing, how long
sitting, and so on)
• How long has [claimant] worked for you? How many days a week do they work?
Are they a permanent or casual employee?
• What difficulties would [claimant] currently have in their regular job?
• Is there any work you can provide that you think [claimant] could currently do,
other than their regular work, to help them return to work earlier?
(Suggest selected duties such as office work, answering phones, and so on, as
appropriate. However, remember it's important the claimant stays active. If the
job was mobile, doing sedentary duties won't always help them achieve a return
to work.)
• (If applicable) Is it realistic for [claimant] to start off returning part-time,
bUilding up to full-time?
• Do you have any concerns about [claimant's] work or injury? (Identify whether
there are any performance issues, whether the employer's able to keep the job
open, and so on.)
• How do you think ACC can help best in this situation? (Use this to gauge the
employer's perception of ACC.)
• (If applicable) Are there any cultural or language issues I should be aware of?
Discussion with claimant's treatment provider
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Contact the claimant's medical practitioner (usually their GP), to gather information
about the injury, and gain their input for developing the IRP.
Checklist
Cover the followlnq points:
• Gather information about the claimant and their injury (as described in Obtain
information from treatment provider).
• Manage their expectations for recovery duration, treatment and outcome, using
the information from the Treatment Profiles and MDA Duration Tables.
11 Accident Compensation Corporation and the National health Committee, Ministry of
Health, Active and Working! Managing Acute Low Back Pain in the Workplace,
Wellington, New Zealand, April 2000
• Clarify the diagnosis, if it's unclear or vague.
• Address any concerns you have about the medical certification they've provided.
If the type of certification isn't consistent with the MDA Duration Tables or
Treatment Profiles, identify what factors contribute to this variation. (If you
can't reach agreement on this with them, consider using RAS12
. )
• Obtain their support for rehabilitation plan and strategies
• If this is a recurrence or re-aggravation of the injury or there are any indications
of underlying condition(s), request copies of any:
• Reports
• X-rays
• records of earlier consultations
• If the claimant's suffered a back injury, discuss the options, identified with the
employer, for rehabilitation in the workplace, and gather their feedback on
these.
Obtaining information from treatment provider
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The following questions give you some suggested phrases to use to obtain the relevant
information from the claimant's treatment provider (such as their GP).
• ACC has [c1aimant]'s injury recorded as [whatever it is], which would indicate
they need an optimum duration of [number of days or weeks] of assistance.
(Ask this to set the provider's expectations, and confirm the diagnosis is
correct. )
• What is the current treatment plan?
(Ask this to clarify any conflicting medical issues that arose when you talked with
the employer and the claimant.)
• Are there any complications to the injury?
• What medical or psychosocial conditions are you aware of that could impact on
[c1aimant]'s recovery?
• Has [claimant] had any previous consultations for this type of injury?
• What work duties do you consider [claimant] is capable of doing at present?
(Discuss any alternative work duties suggested by employer; if applicable,
arrange any change in certification needed.)
• When do you anticipate [claimant] will be able to carry out any work duties?
• When do you anticipate [claimant] will be able to return to full time normal
duties?
• (If applicable) Are there any cultural or language issues I should be aware of?
Confirming cover
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
12 RAS is described fully with information on rehabilitation tools.
Once you've gathered all this information, you need to check the claim details, and
confirm that we can in fact grant cover for this injury.
It's important to review the cover decision at this point, to confirm the cover decision at
the registration centre was correct. As you build up a full base of information about a
claim, if that reveals an issue that affects the validity of the original cover decision
(though this is very rare), we need to identify this as early as possible, and take
appropriate action.
Check the detailed cover criteria, and the legislation, to verify whether the injury should
have cover.
• If cover is appropriate, continue the case management process.
• If you believe that the claimant's injury or condition doesn't have cover under
the current Act, discuss this with your team manager and TCM, and use the
gUidelines described opposite on this page.
Note:
During the life of the claim, you'll periodically review whether the claimant's ongoing
need for entitlements still relates to the personal injury we've granted cover for. If you
find that it's not, you don't revoke cover, but you can suspend their entitlements.
About revoking cover
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If you're considering revoking cover at this stage in the claim's life, you can expect in
most cases to make this decision under Section 73 of the AI Act 199813
• In general,
only revoke cover if the information we have clearly shows we should never have
granted cover for that injury.
The process of revoking cover can leave ACC vulnerable in reviews and appeals, unless
you:
• Follow the correct procedures exactly, and
• Have specific, solid evidence to support your decision.
If needed, get further advice from your team manager and TCM. If it's still unclear, you
could need to get an opinion from Entitlements and Legislation in Corporate Office.
If you do decide to revoke cover, issue a decision letter to the claimant, that clearly:
• Identifies the specific decision we're revoking, including the date we advised it.
• Explains why you've decided to revoke cover.
Procedure: Gather information
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within two days of being allocated the claim, once you've
checked the claim.
1. Contact the claimant, and arrange the interview.
2. Carry out the interview:
13 Section 73 gives ACC the authority to revise a decision, made under the AI Act
1998, that we made in error.
• Give them a copy of fact sheet FSREB01 14
• (If the interview is by phone, send
this to them beforehand.)
• Cover the points on the claimant discussion checklist earlier in this document,
using the suggested phrases to help you obtain the information you need.
• If you wish, complete form ACC12015
•
• If applicable, get the claimant to complete form ACC17416
•
• If pain is an issue, ask the claimant to complete a pain questionnaire, as
described earlier in this document.
• Enter the information, in Pathway, and the IRP.
When meeting with claimants, always follow WorkSAFE policy and practices, and
record you've done so.
3. Contact the employer, and cover the points on the employer discussion checklist
earlier in this document, using the suggested phrases to help you obtain the
information you need. Input the information as you go, in the Rehab Employment
tab in the Management Notebook of Pathway, and in the IRP.
If this is a back injury, identify opportunities for rehabilitation within the workplace.
If appropriate, either:
• Visit the workplace and complete form ACC28017
•
• Send letter GP2618 to an assessor, to arrange for a workplace assessment.
4. Contact the GP, and cover the points on the GP discussion checklist earlier in this
document, using the suggested phrases to help you obtain the information you
need. Input the information as you go, in the Services Provided tab in the
Management Notebook of Pathway, and in the IRP.
5. Check the detailed cover criteria, and confirm cover for the claim.
• If yes, carry out the procedure for assessing the claim's risk.
• If no, contact the claimant and explain clearly why they do not have cover.
Follow this up with a decision letter.
14 Making a rehabilitation plan
15 Claimant initial interview
16 Declaration of responsibilities
17 Return to work workplace checklist
18 Request occupational worksite or job task analysis assessment
3 Assess risk
Identifying barriers to returning to work or
independence
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
c1ai'mslodged under previous acts.
It is important to identify whether the claimant has any barriers to achieving a
rehabilitation outcome (whatever you might agree with them that should be).
This involves reviewing and consolidating the information you've gathered, and
exploring whether they have any difficulties in the following areas:
• . Travel to place of work or usual places for shopping, errands, or their other usual
'·',activities.
• Being at their place of work (or wherever it is they carry out their principal
economic activity).
• Performing usual work or house duties:
• Some of the time, or
• All of the time.
• Whether there are any safety issues in being at place of work (or wherever it is
they carry out their principal economic activity).
• Any other areas you consider relevant to rehabilitation planning, such as cultural
or language issues.
Preliminary check of assistance needed
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once you've got all the initial claim information, and reviewed it with a view to
identifying what barriers the claimant might have, you should have a good initial idea of
what types of assistance the claimant is likely to:
• Need, and
• Be eligible for.
The purpose of making this preliminary check about assistance is to:
• Give you a starting point for discussing the rehabilitation outcome, and
developing the IRP.
• Make sure that you have an idea of what assistance you should encourage the
claimant to apply for, if they haven't already.
There's no structured policy about making this check. Simply consider all the
information you have available, and use your experience and expertise as a case
manager to make an estimate.
About risk assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
A claim's risk is the likelihood that it will cost more than the medical injury alone would
indicate. We assess risk by identifying the factors that could make it more difficult for
the claimant to achieve their rehabilitation outcome. Those difficulties can impact on
the time it takes to achieve the outcome, and additional time means higher costs to
ACC.
Contact centres make risk assessments, and transfer claims to the branch if that results
in a High risk.
You might reassess a claim's risk several times during its life.
Why assess risk
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Experience shows us that looking at psychosocial issues", not injury severity, is the best
way to predict claim duration.
The electronic streaming tool (as described in the cover procedure about streaming)
makes a basic, initial risk assessment, in order to stream the claim. However, because
it's electronic, it can only take very straightforward facts into account, from the data on
the ACC45.
Therefore, it's important to make a more thorough risk assessment, once the branch
(or other managing unit) receives the claim. This means we can identify and manage
the claim for potential risk factors that are too subtle for the system to judge. Also, we
can better allocate and monitor case managers' workloads.
How risk affects case management
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Even if the electronic streaming tool gives a "high" risk rating to the claim, your risk
assessment results (based on the further information you gather) could mean you end
up reclassifying the claim's risk. The streaming tool classifies the claim by a general
comparison against the population history of other such claims, however the risk
assessment examines the particular claim's individual details.
How to make risk assessments
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The risk assessment is not a structured interview. It's a summary of the case coordinator's
or case manager's impression after gathering information from:
• The claimant.
• Their employer and treatment provider.
• Records about the claimant's past injury history.
The case manager collates the information they gathered (using the tools provided, as
described in the procedure for gathering information), and completes the RAC tab in the
Management Notebook in Pathway, which then generates a risk assessment indicator
and category.
1 The claimant's individual attitudes, approach, and personal situation
Completing the RAe
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
To find a claim's risk, complete the risk assessment (RAe) tab in the Management
Notebook in Pathway.
You can use the checklist of alarms and triggers, provided with the rehabilitation tools
in Informe, to help you complete the RAC. You can print this out as a reference for
when you're completing the risk assessments.
Note:
If you don't complete the RAC in Pathway within 48 hours (two working days) of the
claim arriving at the branch, Pathway generates a task to remind you. Branches are
monitored on the number of RAC's completed.
Sources of information
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use these tools, which you used when gathering information, to provide the details you
need for completing the RAC:
• Form ACC1202
• Responses to the list of suggested questions (as described in Gather
information).
Don't ask the claimant questions directly from the text of the RACtab in Pathway.
Those questions aren't worded appropriately for that.
Typical risk indicators
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that-Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Examples of indicators that could signify risk by themselves include:
• The claimant is excessively focused on pain.
• There's a serious threat to the claimant's employment.
• The injury is a recurrence or re-aggravation.
• The claimant has undergone WRAP on a previous claim.
• The claimant has had a lot of other claims.
Indicators like these, for instance, are common reasons why the low risk unit would
transfer a claim to the branch for management.
Note:
If a child or young person has had a lot of claims, investigate this more fully to see if
there is any evidence that might indicate a case of child neglect. Discuss this with the
GP. In these cases, always take special care to avoid making any assumptions or
stating any allegations unless you discover firm evidence.
If pain is an issue
2 Claimant initial interview
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If you identify that pain is an issue for a claimant, ask them to complete form ACC278
or ACC2813 (if they haven't already), as described in Gather information. You need to
take account of the results, and incorporate them into the IRP.
Adjusting case management for risk
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
See Transferring claims for further information on defining high risk claims.
Risk assessments and ongoing monitoring
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
A claim's risk level could change during the life of the claim. It's imperative that we
monitor all claims for risk, so that if it changes at any point, we can immediately make
the appropriate changes to our case management strategies.
This is especially important for low risk claims that escalate to high risk.
We monitor risk by checking for any alarms or triggers that arise (as described in the
monitoring and evaluation procedures). These alarms and triggers alert us to situations
when a claim's risk might have changed. If they do arise, we complete a fresh risk
assessment, as described in this section.
About claim costing
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The detailed instructions for costing a claim are currently being developed, and will be
available on Informe once they're confirmed. This topic provides a general overview
only.
Claim costing is the activity of making an estimate of the likely total cost of the claim,
including:
• Monetary entitlements we're likely to pay to the claimant for the duration of the
claim.
• Treatment, rehabilitation, other assistance and support we're likely to provide.
• Any other claim-related costs that seem likely to arise.
This is only an estimate, based on the information available at this stage of the process
(that is, before you obtain any assessments or decide on what we'll provide). However,
it should be as accurate as possible, based on:
• Your experience of what ACC is likely to be able to provide, which you identified
in your preliminary check of assistance needed.
3 Pain questionnaire - earner, and Pain questionnaire - non-earner
• The risk assessment.
Procedure: Consider claim details and assess risk
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within two working days of receiving the claim at the branch
(or other managing unit).
1. Review the details you now have after completing the procedure for gathering
information.
2. Explore the risk areas you've identified, and check for potential barriers to the
claimant returning to work or independence.
3. Make a preliminary check of the assistance the claimant will probably need and be
entitled to.
4. If you identify pain is an issue (and they haven't already completed it), ask the
claimant to complete form ACC278 or ACC2814 (whichever is appropriate), as
described in Gather information.
If low back pain is also an issue, ask them to also complete the worksheets also
described in Gather information.
5. Input the details you have, into the RACtab on the Management Notebook in
Pathway. Note the risk category that Pathway generates.
6. Review all the results, and adjust your expectations and plans for case management
accordingly. Where appropriate, record this in the IRP.
7. Make a cost estimate for the claim, based on the results of:
• Your preliminary check of assistance needed.
• The risk assessment.
(Instructions for this will be available on Informe soon.)
8. Carry out the rehabilitation procedure for setting the rehabilitation outcome and
agreeing the IRP.
Note:
If you have concerns about the claim's risk assessment results, consult with your team
manager or BMA.
4 Pain questionnaire - earner, or Pain questionnaire - non-earner
Risk assessment alarms and triggers checklist
Examples checklist of indicators or alarm triggers
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use this checklist of examples to help you identify when to complete a fresh risk
assessment for a claim. (You can print this document for easy regular reference.)
Pre-assessment
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
rnanaged under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Is there a significant claims history? For example:
? High number of claims
? History of receiving weekly compensation on another claim for significant period
? History of similar claims
? Currently receiving entitlement on another open claim
Communication
This information relates to ACe's application of the AI Act 1998 and other previous
leqlslatlon that applied under that Act. After 1 April 2002 some claims may still be
rnanaqed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Is it difficult to obtain information from the claimant? For example:
? Cultural or language issues
? Hearing issues
? Refusal to talk
? Unable to contact claimant over two days
? Poor historian (claimant gives vague or conflicting answers)
Medical Information
This information relates to ACe's application of the AI Act 1998 and other previous
1(:~Jislation that applied under that Act. After 1 April 2002 some claims may still be
manaqed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Has the claimant expressed dissatisfaction with their treatment? This can include
signals like:
? Seeing a number of different doctors
? Changing treatments
Are there other conditions that could impact on recovery? For example:
? Medical conditions
? Other injuries
? Drug or alcohol dependence
? Reliance on prescription drugs
0

#11 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 04:50 PM

Page 40,

4 Set outcome
Determining appropriate outcome
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The outcome that you set at this point is referred to as the "indicative rehabilitation
outcome". It "indicates" the point at which we can consider rehabilitation is complete.
Once you've completed the risk assessment, choose the most appropriate outcome for
the claimant, their injury, and their circumstances, from the following:
• Regain independence in everyday activities.
• Maintain employment with same employer.
• Obtain employment.
• Regain an ability to work.
Sequence of outcomes
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
It is possible that, once a claimant achieves an outcome, they could still be entitled to
further .rehabilitation under a further outcome. Most commonly, a claimant receives
rehabilitation toward a vocational rehabilitation outcome; once they achieve it, we set a
new outcome for them to regain independence.
In such cases, always set the vocational outcome as the primary outcome (that is, the
one we attend to first). We can provide social rehabilitation entitlements to the
claimant, through their vocational rehabilitation. Then, once they achieve that, we set
"regain independence" as the secondary outcome, and provide social rehabilitation to
achieve that.
Factors affecting the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Base the decision about the outcome on:
• Whether the outcome is likely to be achieved.
• Whether the outcome is likely to be cost-effective.
• Whether the outcome is appropriate.
• Whether the interventions we provide, to achieve the outcome, can be for the
minimum period needed. (Three years is the maximum perlod.)
• If the claimant was employed at the time of injury.
• The likely ongoing impact of the injury (that is, any long-term or permanent
impairment).
• The employer's ability to keep the job available until they can return to their
previous duties (as much as they can, considering the injury).
• The employer's ability to provide alternative jobs or tasks until the claimant can
return to their previous duties (as much as they can, considering the injury).
• How motivated they are to secure alternative employment.
• Any other relevant information specific to the claimant, such as complicating
medical factors, their skills, training, and experience, etc.
Determining appropriate outcomes (examples)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
~ Evidence indicates the claimant's injury will leave them with a severe permanent
impairment, which will likely prevent them doing any type of work for more than a
few hours a week, even once they have made a full medical recovery, as far as we
expect.
"Regain independence" is the only appropriate outcome for this claimant.
~ The claimant should eventually recover fully from their injury. The current job will
be suitable for them, once they have been fully rehabilitated. Their employer is
keeping the job open, for them to return to it.
"Maintain employment" is appropriate as the primary outcome. When they achieve
that, consider whether we should set "regain independence" as a secondary
outcome.
g The claimant used to work in a manual labour role. They have lost the use of one
arm, so they can't continue in their old job. While their employer would like to
continue their employment, they have no suitable alternative work available.
However, the claimant has other work skills that means they should find other work
fairly easily.
"Obtain employment" is appropriate as the primary outcome. When they achieve
that, consider whether we should set "regain independence" as a secondary
outcome.
Q The claimant has lost their pre-injury job, and is unlikely to secure alternative
employment easily. We have provided rehabilitation to them toward the "obtain
employment" outcome, but this wasn't achieved.
"Regain an ability to work" is most appropriate for the primary outcome. When they
achieve that, consider whether we should set "regain independence" as a secondary
outcome.
Setting duration for claimant's recovery
Generate the MDA durations
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The starting point for setting an expected outcome date is the Medical Disability Adviser
(MDA) duration guidelines. The key information that produces this is the:
• Read Code for the particular type of injury.
• Work Type (light, heavy, manual, etc.) for the job that the claimant will return
to.
The Registration Centre should already have recorded a Read Code in the Basic Claim
Details screen in Pathway, before the claim is allocated to you.
Determine the appropriate Work Type, based on the information you've gathered about
the claimant's work or daily living activities (depending on the applicable outcome).
Check the relevant occupational code from the list, for the usual work type for that job,
as a qulde. Then enter the work type in the Basic Claim Details screen.
Once you've entered this information, Pathway should generate the minimum, optimum
and maximum MDA durations.
Check on the Profile tab in Pathway whether it has done this. If not, refine the Read
Code, using the Read Code browser.
Injuries without an MDA duration
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Not all injuries are listed in the MDA database, so Pathway doesn't always generate a
duration. We've developed durations for some of these injuries. These are listed with
the information about duration management tools'.
We regularly update the information in this list. Whenever this happens, we'll announce
it through the Noticeboard.
Contact the Rehabilitation Help Desk on VPN 7939, if you encounter an injury that's
listed neither:
• In the MDA database.
• On the list of injuries not shown in the MDA database.
Adjusting duration for circumstances
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Under normal circumstances, you can expect a claimant to achieve full functional
capacity within the optimum MDA duration. However:
• Many claimants will recover and return to work earlier.
• Some claimants' recoveries will be delayed.
Once the Read Code is selected, Pathway also returns an ICD9 Code. Use this code to
find the injury in the MDA database. Read the information about the injury and, in
particular, the information on the factors that could influence the duration of this
claimant's incapacity.
Once you've completed the risk assessment, consider the individual circumstances of
the case and determine whether the claimant should be able to achieve the outcome
earlier than the Optimum duration.
Considerations for shortening the duration
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under preVious acts.
Ask these questions to determine if you can expect the outcome to be achieved earlier
than the Optimum duration:
• Is an early return to work possible?
• Does the claimant's GP agree to an earlier timeframe?
1 With the information about the IRP and other rehabilitation tools.
• Is an early return to work likely to be durable and safe?
• Are there any alternative duties available?
Considerations for extending the duration
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once you've completed the risk assessment, consider whether any risk factors apply
that could extend the duration. In addition to the psychosocial? risks, other key risks
include:
• Multiple injuries.
• Complicating factors, like wound infections.
• Pre-existing conditions.
• Delays in detecting or treating the injury.
• Whether the claimant's age is likely to affect healing.
Ask these questions to determine if you can expect the outcome to be achieved later
than the Optimum duration:
• Do any risk factors apply?
• Does the proposed outcome date reflect the relevant additional risks? Is this
appropriate and have the reasons been documented?
• Have the risk factors been mitigated, and the rehabilitation managed correctly?
Note:
Only in very exceptional circumstances should you allow the duration to be longer than
the MDA Maximum duration.
Determining expected outcome date
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Check the Incapacity Date on the Injury/Incapacity tab, which defaults to the Accident
Date. Change this in the followlnq situations.
There was a delay in between
the Accident date and ceasing
work (for weekly
compensation claims) or
seeking entitlements (for
non-weekly compensation
claims).
I The initial incapacity period
. had finished, but subsequent
incapacity has been caused
through re-aggravation of the
injury.
The sole cause of incapacity
Date claimant ceased
work, or was certified as
needing support
Date claimant ceased
work again
Date of discharge
Delayed Incapacity
Re-aggravation
Surgery
2 The claimant's individual attitudes and personal situation
Iis surgery.
Note:
In this last case, Pathway recalculates the durations, based on the Read Code for
surgery that's recorded in the Injury/Incapacity tab.
Finally, add your adjusted duration to the Incapacity Date to give the date you expect
the claimant to achieve the outcome. This is the expected outcome date you will record
in the IRP.
Guidelines for case management timeframes
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use the following timeframes as a guide for how long the case management tasks
should take, that are involved in working toward each outcome.
Maintain employment
Obtain employment
Regain an ability to work
Implementing,
supervising, and
monitoring graduated
return to work
Detailed needs
assessment
Job search
Placement
Detailed needs
assessment
Implementing and
monitoring occupational
enhancement
Work conditioning
8 weeks
3 weeks, plus
1 week for report
4 weeks, plus
1 week for report
4 weeks
(durable fee)
3 weeks, plus
1 week for report
6 weeks, plus
1 week for report
4 weeks, plus
1 week for report
You need to make sure that, if these timeframes are longer than the expected
duration, you shorten the time for the above tasks, to make sure that you don't
exceed the maximum duration for the injury.
Setting milestone dates
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
You need to set a range of dates at which you will monitor the claimant's progress
toward achieving the outcome", (Always complete a risk assessment checklist before
you consider milestone dates.)
These dates act as milestones when you can:
• Expect needs and support to reduce.
3 The monitoring and evaluation procedures, and the purpose of these activities, are
described elsewhere in the rehabilitation process.
• See clear evidence of progress towards the outcome.
The dates you choose will depend on the particular case, and the results on the risk
assessment checklist. It could be appropriate to choose the half way and
three quarter way points toward the outcome date.
Note:
When you have determined the specific interventions we will provide to the claimant,
you will also set milestone dates for monitoring those particular interventions.

\Estimating claim costs
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
To estimate the claim costs, you need to make some preliminary assumptions about the
type of interventions you expect the claimant will need:
• Check the information you have gathered, especially including the results of the
risk assessment, and (if the claimant's completed it) the information on the pain
questionnaire.
• Using your experience, estimate which assessments and other interventions you
expect will be involved.
• For each of these interventions, estimate a duration, or the date when it is
reasonable they should be complete.
• For each intervention, check the service contracts and find the applicable cost of
providing it.
Seek advice from a colleague or your Team Manager if you need assistance in judging
what interventions are likely.
How these estimates are used
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
As the rehabilitation progresses, the actual costs of the interventions are compared to
these estimated costs. The system uses this to determine whether the rehabilitation of
this particular claimant is "running over budget".
This estimate also allows us to plan ahead for the costs we expect to bear in the coming
months.
For both of these reasons, it's important to make sure your estimate is as reasonable
and accurate as possible. Don't be tempted to over-estimate "to be on the safe side",
as this can affect our business financially.
Documenting the outcomes
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
You need to clearly document the outcome (or outcomes) you consider most
appropriate for this claimant.
In the Management Notebook screen in Pathway, make sure you enter the following
information:
• On the Rehab tab, enter the selected outcome(s).
• On the Customised Profile tab, enter the outcome date(s), and the cost
estimates for the claim.
Note:
Once you have input these claim costs, they automatically update, as a total, onto the
IRP tab.
Obtain claimant's agreement
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The first stage of establishing the IRP document is preparing a document on which the
claimant will sign off their agreement to the planned rehabilitation.
Meet in person with the claimant to discuss the rehabilitation outcome, and the
preparation of the IRP.
Note:
If you're completing only a CIS for the claim, you still need to discuss with them your
management plan for their case, but you don't need to ask them to sign off their
agreement.
See these documents in Informe for more details:
• About rehabilitation, for a description of IRP's and CIS's.
• IRP, for full details about IRP's.
Inform claimant
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Make sure the claimant understands the following points:
About the plan:
• Importance of setting an outcome.
• Importance of setting a completion date.
• (IRP only) Importance of their participation in the process.
• (IRP only) They have the right to have a representative involved in each stage of
the preparing the plan.
• (IRP only) Their employer and the treating medical practitioner have the
opportunity to participate in preparing the plan.
About the future:
• (IRP only) Consequences of agreeing to the plan.
• Range of rehabilitation services they could be eligible for.
• Planned outcome and date can be modified, if a needs assessment indicates so.
• The plan can be modified if their progress is unsatisfactory or the rehabilitation
is unsuccessful.
• (IRP only) At the end of the agreed date, a work capacity assessment (WRAP)
could be required.
• (IRP only)The possible consequences of a WRAP assessment.
Obtain agreement
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If you're managing the claim with an IRP, ask the claimant to sign off the plan once
both of you are satisfied that they:
• Understand the points above.
• Agree to the requirements you have outlined.
• Agree to the details of the planned rehabilitation.
If the claimant doesn't agree
If the claimant doesn't agree to sign off the outcome, use the procedure in IRP to
resolve their concerns and arrive at agreement.
Special requirements for back injury claims
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant's applying for entitlements other than treatment, when you interview
them to discuss the IRP, ask them to complete the following forms:
• ACC278 and ACC2814
• ACC2795
Use the results of these questionnaires to:
• Identify whether they're potentially a high-risk case.
• Adjust how you manage the claim to ensure you take the risks into account.
Procedure: Set outcome
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within five working days of being allocated the claim.
1. Decide which of the four outcome options are the most appropriate for this claimant.
2. Use the Duration Management tools to determine the expected outcome date, based
on:
• The duration for the claimant's injury type(s) and type of work.
• Any other risk factors peculiar to the claimant.
If applicable, also take into account the expected time the case management tasks
will take.
3. Determine the appropriate milestone dates for monitoring progress during the
rehabilitation process.
4. Check that you have made these decisions in a legally defensible way.
4 Pain questionnaire - earner and Pain questionnaire - non-earner
5 Work satisfaction questionnaire
5. Estimate the claim costs.
6. Record all this information in the Management Notebook screen in Pathway, in the:
• IRP tab
• Customised Profile tab
7. Meet with the claimant to:
• Make sure they understand the issues, and their role and responsibilities in the
rehabilitation process.
• Obtain their sign-off on the IRP.
• If this is a back injury claim, ask them to complete forms ACC278 and ACC2816
,
and form ACC2797
•
8. If the score on the pain questionnaire is over 105, refer the case to the BMA for
comment on managing the claim.
6 Pain questionnaire - earner and Pain questionnaire - non-earner
7 Work satisfaction questionnaire
5 Assess needs and implement referrals
Objectives of assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The aims of the assessments are:
• To confirm that the rehabilitation outcome is the most appropriate option for this
claimant.
• To determine the specific needs the claimant has, that have to be met in order
to achieve the outcome.
• To determine the best types of interventions that will meet those needs, to
achieve the outcome within the requirements (cost effectiveness, durable
results, etc.).
The assessment also provides more precise cost estimates for the possible
interventions.
Definition of outcome-focused assessment
All ACC rehabilitation assessments have to be outcome-focused.
An outcome-focused assessment is one that concentrates on the agreed rehabilitation
outcome. It focuses on identifying what needs the claimant has, that have to be met if
the claimant is to achieve the outcome.
Assessing for social rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the outcome is to "regain independence in everyday activities", the purpose of the
assessment is to identify:
• The claimant's current ability to achieve the outcome.
• Any barriers preventing them from achieving it.
• The risks involved in trying to achieve it.
• The needs they have, to be able to achieve it.
If the claimant's outcome is a vocational one, you can still assess for and provide social
rehabilitation, if it will contribute to achieving the vocational rehabilitation outcome.
What assessments need to cover
All assessments for social rehabilitation need to cover:
• Any recorded changes in the claimant's condition.
• The activities of daily living that they were able to perform before their injury.
• The activities they can perform following the injury.
• The limitations they suffer as a result of their injury.
• The appropriate types of social rehabilitation interventions that would minimise
these limitations.
• Confirmation that providing those interventions would achieve this outcome.
• The alternatives and options available to provide those interventions in the most
cost-effective way.
• If the claimant is entitled to vocational rehabilitation, any social rehabilitation
interventions that would also help them participate in employment.
• Any issues relating to the geographical location, where the claimant lives.
• If the claimant has already been provided with other interventions (particularly
equipment), any changes in the sultablllty of those interventions.
Assessing for vocational rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Assessments for vocational rehabilitation need to cover:
• The information relevant to the particular outcome (as follows).
• What social rehabilitation will also support this.
Outcome: Maintain Employment
Assessments need to cover the support strategies needed to:
• Secure the claimant's pre-injury employment.
• Return the claimant to their pre-Injury level of employment (both in the number
of hours they work, and the types of tasks they carry out).
Outcome: Obtain Employment
Assessments need to cover:
• The alternative job options suitable for the claimant.
• The claimant's transferable skills.
• Any other issues or barriers to achieVing the outcome.
• Recommendations for the steps a claimant could take to achieve paid
employment regarding the identified job options.
• Any short term training the claimant needs, in order to use their pre-injury skills
to obtain an alternative job.
Outcome: Regain an Ability to Work
Assessments need to cover:
• Alternative job type options, suitable for the claimant.
• The claimant's transferable skills.
• Any short training courses the claimant needs, to become suitable for the
alternative job options.
• Any other issues or barriers to achieving the outcome.
• Recommendations for the steps a claimant could take, to achieve paid
employment in the identified job options.
Note:
Before you decide about provldlnq work-related interventions, you need to confirm with
the GP that:
• The alternative employment options are suitable, considering the injury's
conseq uences.
• No injury-related conditions remain that prevent the claimant from returning to
the work force.
• What they have indicated is what the claimant is capable of doing, not what
they're currently doing.
Determining what assessments to obtain
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Examine the information you have collected to date. Determine the specific needs that
the claimant has, which we could meet by providing interventions under the various
types of entitlement.
Keep a focus on the agreed rehabilitation outcome. Concentrate on what is currently
preventing the claimant from achieving their rehabilitation outcome.
Then check the eligibility criteria for each type of entitlement you have ldentlfted", for
the applicable social rehabilitation and vocational rehabilitation interventions.
Note:
Assessments for medical rehabilitation (treatment) are specific to the claimant's injury
and medical condition. These are not covered here.
Making referrals for assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
For each entitlement or intervention the claimant is eligible for, arrange a referral for
the claimant to undergo a detailed assessment. Request the referrals using:
• Form ACC081 for social rehabilitation assessments.
• The relevant form for vocational rehabilitation assessments (as detailed in the
relevant entitlements).
These assessments count as interventions. However, their purpose is not to
rehabilitate the claimant, but to help you decide what other interventions to provide.
Select assessor
Select an appropriate assessor from the list, who specialises in the type of support. For
example, if the claimant needs help with day-to-day transport, look for an assessor who
specialises in vehicle modification assessments.
Use assessment "packages"
Some assessors can assess for several entitlements at once, for example, personal care
and home help. Where possible, combine the assessments into a package so that the
claimant has to undergo as few individual assessments as possible.
If this isn't possible, you need to arrange the different assessments to happen
concurrently, so that you can make all your resulting decisions as early as possible.
Record referrals
1 These criteria are described under each entitlement type.
Record the following information in the IRP:
• The type of each entitlement to be assessed.
• Who you have referred each assessment to.
• The date you made each referral.
• The date each assessment is due to be completed.
• The responsibilities of the claimant, the assessor and you, for each assessment.
Record the following information in Pathway:
• Date referred (on the IRP tab in the Management Notebook).
• Expected completion date (as a task).
How the assessment process works
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
What the assessor does
Each assessor examines the claimant's requirements, in consultation with the claimant.
They provide an assessment report covering each type of entitlement, detailing the
extent and particulars of the services the claimant needs.
These assessments are outcome-focused, concentrating on the specific interventions
the claimant needs, to help achieve the rehabilitation outcome.
The assessment report
Each type of assessment report covers different types of technical detail, but all reports
list:
• The claimant's specific assessed needs under this entitlement.
• How meeting these needs will help the claimant achieve the rehabilitation
outcome.
• The appropriate specific options to meet these needs.
• A cost estimate for each option.
• The assessor's recommendation about which option(s) will be the most effective
for meeting the needs, and so support the claimant to achieve the outcome(s).
• A rationale supporting each of the recommendations.
Checking the quality of the assessments
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
You should never make any decisions about interventions until you are confident the
assessment is of suitable quality.
For each assessment, use this checklist to check.
• The assessment doesn't omit any significant information, and answers all the
questions asked in the referral.
• The assessment is focussed on the outcome.
• The interventions described are based on the claimant's needs.
• The interventions are focussed on the outcome.
• The interventions are likely to be cost-effective.
• The interventions relate only to the needs that arose because of the injury.
• The assessment identifies all the practicable alternatives and options that could
help the claimant achieve the outcome.
• It clearly indicates which alternatives are the most cost-effective, and which are
the most effective for the claimant.
If assessment doesn't measure up
If the assessment doesn't meet anyone or more of these requirements, you need to
return it to the assessor.
Advise them what your concern is, and ask them to correct or complete the information
that is missing or unsuitable.
Paying for assessments
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
When you receive the assessor's invoice, you need to check you have in fact received
the assessment report, then enter the payment in IIS.
When you enter the payment, use the:
• Applicable amount(s) for the particular service contract.
• Appropriate account code for the particular assessment type.
Note:
If a service contract has been established for the assessment type, the applicable fees
are stated in the description of the particular entitlement.
At the time this was written, not all service contracts had yet been finalised. As each
one becomes available, the pricing information will be updated in Informe, and
announced through the Noticeboard.
Procedure: Assess needs and implement referrals
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within five days of being allocated the claim.
1. Confirm that there is a written application for rehabilitation support on file.
2. Determine which entitlements cover the claimant's identified needs, for treatment,
and vocational and social rehabilitation. Check the claimant's eligibility for each of
these entitlement types.
3. For each· entitlement type the claimant is eligible for, define the responsibilities of
the assessor, the claimant, and yourself.
4. For each planned assessment, select an assessor and make a referral.
Where possible, package multiple assessments to a single assessor. Carry out all
separate assessments concurrently.
5. Document the referrals in the IRP in Pathway.
6. Record the followlnq information:
• In the IRP, the actual completion date, and the cost of the assessment.
• In Pathways, enter a task as a reminder, for the date when the assessment
should be complete.
7. Check the quality of the assessment, and resolve any issues.
8. When you receive the invoice, pay for the assessment.


that lots tells what the assessor is there for. that is the first 50 pages of approx 1500 alot of the information is repeated but this is the policies that the AG used when he examined the policies to see if they allowed the staff to apply legislation.
0

#12 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 04:54 PM

one of the most inportant parts for the casemanagement

6 Plan and make decisions
Using the assessment to guide your decision-making
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Planning and decision-making is fundamental to effective rehabilitation. It's about
determining the appropriate strategies.
Identify whether the assessment:
• Identifies any new medical information that means you should review the
claimant's cover.
• Confirms the choice of outcome(s) is appropriate.
• Confirms the outcome date is appropriate.
Always document your decision-making process (the results of using the tools) on the
Pathway activity log, so you can prove you've used professional judgement
appropriately in applying the legal requirements. Using the process ensures your
decisions are legally defensible, should the claimant challenge the way their
rehabilitation has been managed.
Deciding what interventions to provide
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Examine the options and alternatives shown in the assessment. Identify the option that
best fits all of the requirements for providing interventions.
If it's unclear which option is best (for example, if none of the options is without a
significant flaw), you should seek:
• Clarification from the assessor.
• Assistance from an experienced colleague or your Team Manager (or both).
Alternative jobs
If the outcome is to "Maintain employment" or "Obtain employment", you might be able
to propose specific jobs that are available for them.
If such jobs are available, you need to:
• Identify these on the IRP.
• Make sure that the claimant, their employer, and their medical practitioner all
agree to them. .
If it's appropriate to do this, you need to make sure you can still meet the deadline for
the overall procedure.
Delegating the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once you have determined the best option, determine who has the delegated authority
to make this decision.
If you don't have sufficient authority, delegate the decision-making to the appropriate
person. Ensure you include all the relevant information on which you based your
considerations, and make a recommendation.
Testing the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Before you put the decisions into action, you need to test them, to make sure they are
sufficiently robust to be legally defensible. Test each decision with the following
questions:
• Does the decision pass the Seven Questions test?
• Does the decision pass the Test of Reasonableness?
• Is this the best type of service, for the minimum period, to achieve the purpose,
and provide a durable outcome?
• Does it take account of the claimant's cultural, social, and employment
background?
• Does it take account of the consequences of the injury?
• Was the decision made at the correct level of delegation?
• Does the case file include all the information that you need to make the decision
correctly?
• Does this intervention relate to what the claimant needs, as opposed to what
they want?
Information needed to support the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
When you are considering making a costly intervention (such as lengthy vocational
retraining, or the purchase of a vehicle), you need to make sure all of the following
information is recorded in the case file, to demonstrate the basis of your considerations,
justifying why we should complete this intervention.
Executive summary
1. Biographical details (on paper in the file)
• Claimant's name
• Case number
• Date of birth
• Date of injury
• (if applicable) Serious Injury Profile (including the descriptor, profile number and
CPI indicator)
• Case manager's name
• Branch office
2. Brief file summary (in Pathway, and a hard copy to the person who holds delegation
for the decision)
3. Summary of the assessment options identified (preferably in Pathway)
4. Case manager's recommendations (in Pathway), including:
• Explicit link to the primary outcome.
• Evidence of using the decision-making process and tools.
• Reference to the relevant sections of the Act that relate to this claim.
• Reference to the relevant, specific areas of ACC policy that relate to this claim.
5. References for the above (in Pathway), to:
• The delegation level appropriate for the recommended interventions.
• Coding of social or vocational rehabilitation entitlements.
• Relevant service provider contracts.
6. Attachments (in Pathway):
• Assessment reports (or SIA report, if applicable).
• IRP.
• Pathway activity log (as a reference only).
7. Responses to any requests for delegated decision-making (in Pathway), especially if
declined. This needs to show:
• That the case manager's submission has been duly considered.
• Why the recommended interventions aren't considered the most appropriate
options to lead the claimant to achieving the outcome.
• References to the relevant sections of the Act, and ACC policy.
8. Costings for each of the recommended and agreed interventions (in the customised
profile of Pathway).
Procedure: Make decisions
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within five days of receiving the assessment information.
1. Based on information from the report(s):
• Check if any new medical information has come to light that affects the
claimant's cover.
• Confirm the rehabilitation outcome and outcome date are still appropriate and
achievable.
2. If appropriate, negotiate with the claimant, GP and employer to bring the expected
outcome date forward.
3. For each assessment, examine the options and alternatives.
4. Based on the assessments, decide on the most appropriate interventions to provide.
If needed, pass the authority for making the decisions up to the appropriate level of
delegation.
5. Test each decision using the decision-making tools.
6. Determine the timeframes for each intervention.
7. Update the IRP with the planned decisions.
8. Record any key dates for the interventions in the IRP page of the Management
Notebook screen. Enter a task in Pathway for milestone dates to monitor the
interventions.
9. With the claimant:
• Explain what interventions we will be providing.
• For each intervention, define your responsibilities, the claimant's, and the
service provider's.
• Once they agree to the interventions, update the IRP.
Note:
• You can do this by phone.
• You must contact the claimant as early as possible, to allow them time to fully
consider the interventions before deciding to agree.
• If appropriate, repeat this with the claimant's GP, and employer. If needed, you
can arrange a meeting.
• If this is a back injury claim, make sure you discuss with the GP in detail, the
rehabilitation options you've identified in the workplace.
10. Make sure the claimant signs the most up-to-date version of the IRP.
11. Confirm and (if necessary) adjust the expected total claim costs, on the Profile tab
of the Case Notebook in Pathway.

6 Plan and make decisions
Using the assessment to guide your decision-making
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Planning and decision-making is fundamental to effective rehabilitation. It's about
determining the appropriate strategies.
Identify whether the assessment:
• Identifies any new medical information that means you should review the
claimant's cover.
• Confirms the choice of outcome(s) is appropriate.
• Confirms the outcome date is appropriate.
Always document your decision-making process (the results of using the tools) on the
Pathway activity log, so you can prove you've used professional judgement
appropriately in applying the legal requirements. Using the process ensures your
decisions are legally defensible, should the claimant challenge the way their
rehabilitation has been managed.
Deciding what interventions to provide
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Examine the options and alternatives shown in the assessment. Identify the option that
best fits all of the requirements for providing interventions.
If it's unclear which option is best (for example, if none of the options is without a
significant flaw), you should seek:
• Clarification from the assessor.
• Assistance from an experienced colleague or your Team Manager (or both).
Alternative jobs
If the outcome is to "Maintain employment" or "Obtain employment", you might be able
to propose specific jobs that are available for them.
If such jobs are available, you need to:
• Identify these on the IRP.
• Make sure that the claimant, their employer, and their medical practitioner all
agree to them.
If it's appropriate to do this, you need to make sure you can still meet the deadline for
the overall procedure.
Delegating the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once you have determined the best option, determine who has the delegated authority
to make this decision.
If you don't have sufficient authority, delegate the decision-making to the appropriate
person. Ensure you include all the relevant information on which you based your
considerations, and make a recommendation.
Testing the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Before you put the decisions into action, you need to test them, to make sure they are
sufficiently robust to be legally defensible. Test each decision with the following
questions:
• Does the decision pass the Seven Questions test?
• Does the decision pass the Test of Reasonableness?
• Is this the best type of service, for the minimum period, to achieve the purpose,
and provide a durable outcome?
• Does it take account of the claimant's cultural, social, and employment
background?
• Does it take account of the consequences of the injury?
• Was the decision made at the correct level of delegation?
• Does the case file include all the information that you need to make the decision
correctly?
• Does this intervention relate to what the claimant needs, as opposed to what
they want?
Information needed to support the decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
When you are considering making a costly intervention (such as lengthy vocational
retraining, or the purchase of a vehicle), you need to make sure all of the following
information is recorded in the case file, to demonstrate the basis of your considerations,
justifying why we should complete this intervention.
Executive summary
1. Biographical details (on paper in the file)
• Claimant's name
• Case number
• Date of birth
• Date of injury
• (if applicable) Serious Injury Profile (including the descriptor, profile number and
CPI indicator)
• Case manager's name
• Branch office
2. Brief file summary (in Pathway, and a hard copy to the person who holds delegation
for the decision)
3. Summary of the assessment options identified (preferably in Pathway)
4. Case manager's recommendations (in Pathway), including:
• Explicit link to the primary outcome.
• Evidence of using the decision-making process and tools.
• Reference to the relevant sections of the Act that relate to this claim.
• Reference to the relevant, specific areas of ACC policy that relate to this claim.
5. References for the above (in Pathway), to:
• The delegation level appropriate for the recommended interventions.
• Coding of social or vocational rehabilitation entitlements.
• Relevant service provider contracts.
6. Attachments (in Pathway):
• Assessment reports (or SIA report, if applicable).
• IRP.
• Pathway activity log (as a reference only).
7. Responses to any requests for delegated decision-making (in Pathway), especially if
declined. This needs to show:
• That the case manager's submission has been duly considered.
• Why the recommended interventions aren't considered the most appropriate
options to lead the claimant to achieving the outcome.
• References to the relevant sections of the Act, and ACC policy.
8. Costings for each of the recommended and agreed interventions (in the customised
profile of Pathway).
Procedure: Make decisions
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within five days of receiving the assessment information.
1. Based on information from the report(s):
• Check if any new medical information has come to light that affects the
claimant's cover.
• Confirm the rehabilitation outcome and outcome date are still appropriate and
achievable.
2. If appropriate, negotiate with the claimant, GP and employer to bring the expected
outcome date forward.
3. For each assessment, examine the options and alternatives.
4. Based on the assessments, decide on the most appropriate interventions to provide.
If needed, pass the authority for making the decisions up to the appropriate level of
delegation.
S. Test each decision using the decision-making tools.
6. Determine the timeframes for each intervention.
7. Update the IRP with the planned decisions.
8. Record any key dates for the interventions in the IRP page of the Management
Notebook screen. Enter a task in Pathway for milestone dates to monitor the
interventions.
9. With the claimant:
• Explain what interventions we will be providing.
• For each intervention, define your responsibilities, the claimant's, and the
service provider's.
• Once they agree to the interventions, update the IRP.
Note:
• You can do this by phone.
• You must contact the claimant as early as possible, to allow them time to fully
consider the interventions before deciding to agree.
• If appropriate, repeat this with the claimant's GP, and employer. If needed, you
can arrange a meeting.
• If this is a back injury claim, make sure you discuss with the GP in detail, the
rehabilitation options you've identified in the workplace.
10. Make sure the claimant signs the most up-to-date version of the IRP.
11. Confirm and (if necessary) adjust the expected total claim costs, on the Profile tab
of the Case Notebook in Pathway.

that important that they repeat the section.
0

#13 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 04:57 PM

7 Implement monitor evaluate and exit
Implementation
Overview of implementing the IRpl (or CIS)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once you've agreed with the claimant on the interventions we'll provide them, you need
to put those plans into action. The exact details will depend on the individual
tnterventlons", however, keep these points in mind for all of them:
• Where possible, arrange for a single service provider to provide as many of the
interventions as possible, in a single package. This improves cost-effectiveness,
and reduces the number of providers the claimant deals with.
• If that's not possible, then (as much as possible) provide the interventions
concurrently with other interventions, using separate providers.
• Start providing interventions as promptly as possible. Delays in implementing
the IRP can delay the outcome.
• Provide all interventions provided according to a pre-determined, agreed
timeframe. Plan to complete all interventions by the expected outcome date.
• Clearly define responsibilities for each intervention, detailing who's responsible
for what aspects of it. For example, the claimant might select the home help
provider, but you might select the workplace assessor.
Using a CIS instead of an IRP
Remember, you can use the case intervention strategy (CIS) in Pathway (instead of an
IRP), if your risk assessment shows the claim is low risk. An IRP involves the claimant's
full participation and agreement, but the CIS is a simple management plan for you to
use. A CIS doesn't need the claimant's signature.
If you're using a CIS for the claim, use the same approach to implement your plans, as
for implementing the IRP.
However, even if the claim is low risk, always escalate a CIS into a full IRP if you find:
• The claimant is likely to need assistance for more than 13 weeks.
• The claimant doesn't make expected progress.
• The claim's risk has increased to medium or high risk.
Making arrangements with the service provider
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Many rehabilitation interventions are contracted to specific contracted service providers,
with whom we have negotiated prices, quality standards, terms and conditions, etc.
This means we can provide consistent service quality, for a consistent cost.
In many cases, to implement the intervention, we need only to provide the relevant
details to the contracted service provider, making the referral for them to provide the
1 Implementing the IRP is described more fully with the rehabilitation tools.
2 These are described fully under each individual entitlement.
intervention to the claimant. Then they begin providing the required services.
The specific information the service provider needs, depends on the type of
intervention, and the claimant's particular circumstances and needs.
Most of these service contracts require the service provider to confirm any referrals we
send them within two working days (or within the timeframe specified in their provider
contract, as per the list in Informe). If they don't, we need to contact them to make
sure that they accept the referral.
Procedure: Implement planned interventions
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure for each intervention, either:
• As soon as the decision to provide it has been made and agreed to, or
• At the specific time agreed in the IRP (or CIS).
1. Identify the applicable service provision contract, and the service providers who
hold current contracts with us for that service.
2. Select the service provider, and forward a service referral to them to arrange for
them to start the assistance.
3. If the service provider doesn't confirm acceptance of the referral within two working
days (or the timeframe specified in their contract), contact them to clarify their
acceptance.
4. Check you have entered tasks on Pathway for the relevant milestone dates, when
you will monitor the intervention:
• While it's being implemented.
• When it should be complete.
5. As you receive the invoices for the services provided:
• Make sure the amounts don't exceed the expected costs.
• Enter these promptly for payment when they are due.
Monitoring progress
When to monitor
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Monitoring the claimant's progress is a "continuous improvement" activity. It alerts you
early if the claimant is unlikely to achieve the outcome, so you can make appropriate
changes to the IRP (or CIS) as they become necessary, or escalate a CIS into a full IRP.
You monitor progress:
• Ongoing, every time you speak to the claimant or receive new information,
(such as a medical certificate), keeping alert for alarms and triggers that could
indicate a change in the claim's risk, and
• At specific milestone dates, as detailed in the IRP (or CIS), making a more
formal check.
Ongoing monitoring
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Contact the claimant each week during a vocational rehabilitation intervention, to
monitor progress.
If the interventions involve a gradual return to work, it is good practice to always
contact the employer on a regular basis, to ensure that all is proceeding as expected.
This is valuable, both for monitoring effectively, and for maintaining a good relationship
with the claimant's employer.
Service providers are required to provide regular reports. Make sure that:
• They do provide the reports and the reports are to schedule (as required in the
service contract).
• The content of the reports is informative and complete.
• The information shows they are meeting the organisational quality standards
specified in the contract agreement.
About alarms and triggers
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
There's always the possibility that a claim, assessed as low risk at initial evaluation,
could escalate to high risk as we progress through the case management process with
the claimant. It's important to identify early any change in risk, report it, and act on it.
Typical alarms and trigger types
Alarms and triggers include situations like these:
• The claim exceeds its optimum duration for the injury.
• The claimant doesn't achieve their rehabilitation outcome within the agreed or
extended timeframe.
• The claim exceeds the maximum duration for the injury.
• The case manager's intuition gives them a "bad gut feeling" about the claim.
• An event occurs that significantly changes the claimant's ability to achieve their
outcome.
• You discover new information about the claimant, their injury, or their situation,
that affects the risk level.
• When you're monitoring at milestone points, you find the claimant isn't making
the expected progress toward their outcome.
Use the alarms and triggers checklist to help you identify alarms and triggers.
What to do if there's an alarm or trigger
If any of these situations arise, complete a fresh risk assessment using the RAC in
Pathway. That can provide you with the drivers behind the relevant alarms or triggers.
You then need to take account of the results of the risk assessment, and incorporate
into the IRP both the information you've found, and what you plan to do as a result.
How to stay alert for alarms and triggers
Keeping regular contact with the claimant allows you to identify early if any concerns
arise. Such contact allows a relationship to develop between the case manager and
claimant, and stresses to the claimant our expectation that they'll return to work or
independence.
Making risk reassessments
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Pathway reminders
Pathway generates a Task to remind you to review the claim when:
• The claim duration reaches the MDA optimum.
• The outcome date in the CIS for the claim arrives.
Reassessing at optimum duration date
If the claim has reached optimum duration, and there isn't a definite exit date within
two weeks of the optimum duration date (or the maximum duration, whichever is
earlier), you need to complete a fresh risk assessment when Pathway raises the"Task to
review the claim.
The purpose of this is to identify any further risk factors that might present themselves
as the claim progresses, which might not have been obvious during the initial
assessment.
Reassessing on "gut feeling"
Complete a fresh risk assessment whenever you get a feeling that the claim isn't
progressing, and the claimant could have psychcsoclaf barriers to returning to work or
independence.
Reassessing at maximum duration date
If a claim reaches maximum duration, Pathway reminds you to review the claim. It's
recommended you complete a fresh risk assessment and discuss management
strategies with your Team Manager.
You could also be required to complete a maximum duration management plan at this
time.
Completing a maximum duration management plan
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The maximum duration management plan is a checklist in electronic format. All Team
Managers have access to it. The purpose of the maximum duration management plan
is to:
• Prevent a new claim "tail" from developing.
• Give the claim an independent review.
• Ensure the management of more "difficult" claims remains focused and
proactive.
• Check the claim does have ongoing entitlement.
• Make sure claimants are receiving effective and appropriate rehabilitation.
• Identify any gaps in the purchase of rehabilitation services.
3 The claimant's individual attitude and personal situation
When to complete
A random selection is made each month of claims that have exceeded their maximum
duration. You'll be advised if you need to complete a review for a claim you're
managing.
Note:
If the claim is a work injury, and you've been asked to undertake the case management
on the claim, the case co-ordinator will complete the maximum duration management
plan in conjunction with you.
What the case manager (or co-ordinator) does
Instructions for how to complete the checklist are given on the front of the review
checklist. You'll need to input any of the following details, if they aren't displayed:
• Accident and claimant details
• Details of treatment provided and treatment outstanding
• Injury complications
• 'Reason for exceeding maximum duration
• Whether pain is a presenting factor
• Details of interventions provided to date
• Proposed rehabilitation plan including all expenditure and expected outcome
date.
Once it's complete, e-mail the checklist to the Claims Monitoring Unit (CMU). The
GroupWise e-mail address is "maximumdurationclaims" (Without the quotes).
Note:
The branch also sends the CMU exception reports each month, detailing any milestones
that haven't been achieved.
What the eMU does
The CMU monitors the claim's progress, and (if needed) requests more information
from you.
Monitoring at milestone dates
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
At each pre-determined milestone date for a specific intervention, monitor the provision
of the intervention, and the claimant's general progress toward the outcome.
In consultation with the claimant (and if appropriate, the service provider), seek
answers to the following questions:
• Is the intervention being provided according to plan?
Are quality standards being met?
• Has providing this intervention had the planned impact on the relevant assessed
needs?
How does it compare to the expected effectiveness?
Has the service provider indicated any decline in progress (for example through
a report)?
• Is progress as planned toward the outcome?
Is the claimant still likely to achieve it?
• At this point, how likely are the current and future interventions to achieve the
planned impact?
If all is as planned (or better), continue:
• Providing the intervention, and
• Your ongoing monitoring.
If anything is not progressing as planned, you need to take action to correct the
problem. For example, the service contract might allow you to terminate the referral.
Taking action if progress isn't satisfactory
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If you identify that progress isn't as planned you need to take action, in consultation
with the claimant, to realign the plans in the IRP with realistic expectations of success.
It's important to make sure you do this promptly, so that ineffective interventions don't
waste further costs.
Note:
If the claim has only a CIS, you need to develop an IRP with the claimant now.
Identify the cause
The first thing you need to do is identify why the claimant hasn't progressed as
expected. This could be because:
• The planned interventions weren't appropriate.
• Other contributing factors have developed.
• The intervention isn't being provided as planned.
• The outcome or outcome date wasn't realistic.
• The claimant isn't taking sufficient responsibility for their own rehabilitation.
If you need to gather more information, you can contact the claimant's employer or GP.
Reassess risk
Whenever the claimant isn't making the expected progress, you need to complete a
fresh risk assessment (as described in the procedure for risk assessments you complete
at the beginning of the rehabilitation process).
Consider corrective action
Once you know what the problem is, take the appropriate corrective action. This could
include any of the following:
• If service quality standards aren't being met, you need to contact the provider
and resolve the issue.
• If the service provider has raised issues in the reports they've submitted, you
need to respond to these.
• Consider getting further information regarding the claimant's medical progress.
• Consider altering how the intervention is being provided, such as changing
service providers, or increasing frequency of the service, etc.
• Consider swltchlnq to alternative types of intervention to meet the claimant's
needs.
• Consider swltchlnq to a different outcome. If the current outcome is to "obtain
employment", consider sWitching to "regain an ability to work".
• Review the underlying strategies you're using.
• Consider using other tools to assist in achieving the outcome (for example,
WCAP).
• If there are unexpected complications, you could need to completely reassess
what the claimant needs to achieve the outcome.
Obtain claimant's agreement
Whatever action you decide is needed, you have to seek the claimant's agreement on
the IRP, their GP's, and (if applicable) their employer's. (A case conference can be an
effective method to achieve thls.)
Procedure: Monitor progress
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Follow this procedure when:
• You receive ongoing information while the interventions are being provided.
• A milestone date arrives.
• The date arrives when an intervention should be complete.
• An alarm or trigger is raised.
o Claim exceeds MDA optimum or maximum duration.
1. Check the available information.
2. If you are monitoring an intervention that's been completed, enter the actual
completion date in the IRP or CIS tab in the Management Notebook.
3. If the claim has exceeded the maximum duration, and you're asked to complete a
Maximum Duration Checklist (MDR), do so and send it to the Claims Monitoring Unit.
4. Is everything as planned and expected?
• If yes, you don't need to take any further action until either you receive further
information, or another milestone or completion date arrives.
• If no, continue this procedure.
5. Contact the claimant and (if appropriate) their employer and GP, and gather the
information you need to be able to complete a fresh risk assessment.
If you discover pain is an issue, ask the claimant to complete form ACC278
or ACC2814 (as described in the procedure for gathering information).
6. Complete a fresh risk assessment (as described in the procedures for completing an
initial risk assessment).
7. Take corrective action, by:
• Identifying the cause of the delay or problem.
• Determining what action will correct that problem.
• Escalating a CIS to an IRP
• Testing your decision-making.
o Agreeing on the changes with the claimant and (if applicable) their employer
• Updating the IRP, and obtaining their sign-off.
o Implementing the agreed changes.
4 Pain questionnaire - earner, or Pain questionnaire - non-earner
8. Continue ongoing monitoring of the interventions.
Evaluating at outcome date
About evaluation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Evaluation occurs on the outcome date, at the end of the rehabilitation process. It
involves:
• Looking at the IRP (or CIS).
• Evaluating the overall progress.
• Determining whether the outcome has been achieved.
Ask the following questions:
• Has progress occurred as expected and planned?
• What have we learnt?
• What progress have we made, that we can build on?
• Have the services met the contract conditions?
• Is the IRP adequate?
• Were the outcome and outcome date appropriate?
Note:
You are expected to evaluate your own performance in how you have managed the
rehabilitation of each claimant.
Rating service providers' performance
When the outcome is achieved, you need to record your evaluation of each service
provider's performance, for their quality of service for the intervention they provided.
Update the information in the Service Provider tab in the Management Notebook on
Pathway, using the following codes:
1 Poor
2 Average
l-
:I 3 Good
4 Very good
5 Excellent
Determining if outcome achieved
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The outcome is achieved when:
• All interventions planned in the IRP or CIS are complete; and
• Claimant reaches the indicative point for the outcome.
If claimant hasn't achieved the outcome by the expected outcome date, you need to
reconsider the IRP. Also, if the management plan for the claim is only a CIS, consider
whether you need to develop an IRP.
Indicative point: regain independence
The indicative point for this outcome is when the claimant reaches the optimum level of
independence in their everyday activities, considering the consequences of the injury.
Note:
Some interventions continue on an ongoing basis, such as medical consumable
products. If so, the above criteria mightn't quite fit, as the interventions aren't exactly
"complete".
Indicative point: maintain employment
The indicative point for this outcome is when the claimant is working for their pre-injury
employer, for the number of hours they worked before the injury.
Indicative point: obtain employment
The indicative point for this outcome is when the claimant is working in a suitable job,
for either:
• More than 30 hours a week.
• The number of hours they worked before the injury
Indicative point: regain an ability to work
The indicative point for this outcome is when the consequences of the injury don't
prevent the claimant from:
• Seeking employment independently.
• Undertaking employment they are suited for, by education, experience or
training.
• Working for 30 hours or more a week in a suitable job.
Reconsidering the outcome and IRP
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If your evaluation at the outcome date shows it hasn't been achieved, you need to take
action. This is similar to what you do if you find progress isn't as planned at a
milestone date. That is, you:
• Identify the problem, or reason for the delay.
• Reassess risk.
• Consider and plan action to correct that problem.
• Obtain the claimant's agreement to any changes to their plan, and their GP's,
and (if applicable) their employer's.
• Escalate a CIS to an IRP
Because you are at the end of the process, you need to consider what further
rehabilitation and relevant tools are needed to achieve the outcome.
If all those available seem unlikely to succeed, reassess the claimant's needs. You
could need to:
• Go right back through the assessment and decision-making stages of the
process to find the means to achieve the existing outcome.
• Reconsider which outcome is most appropriate.
If needed, consult with your SMA.
Peer review
You might consider it appropriate to request another member of your team to carry out
a peer review of the case. This can provide a fresh perspective, alternative opinions, or
a different direction.
What to examine
Ask the following questions:
• Is the claimant still eligible for ongoing rehabilitation?
• What has delayed their progress?
• What have we learnt?
• What progress have we made, that can we build on?
• Were the assessments we undertook appropriate?
• Was the existing employment suitable, given the nature of the injury and the
nature of the workplace?
• Was the IRP adequate?
• Was the outcome appropriate for the claimant?
• Are there unexpected complications that mean we should obtain other
information or revise the plan?
Procedure: Evaluate at outcome date
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within two days of the earlier of:
• The expected outcome date.
• The date all planned interventions are completed.
1. Check that all the interventions have been completed as planned.
2. Evaluate whether the claimant has achieved the outcome.
• If yes, exit the claimant.
• If no, continue this procedure.
3. Take corrective action:
• Identify the cause of the delay or problem.
• Reassess risk, using the RAC if necessary (as described in the procedure for
assessing risk).
• Escalate a CIS to an IRP
• Decide what action will correct that situation.
• Test that decision-making.
• Agree on the changes with the claimant and (if applicable) their employer.
• Implement the changes.
4. Continue ongoing monitoring of the interventions.
Conducting the cessation interview
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once the outcome has been achieved, arrange an interview with the claimant to discuss
the exit from their claim. (You can do this by phone, if approprlate.)
In this interview, cover the following points:
• Ask the claimant to verify that they've achieved the outcome as stated in the IRP
(or CIS).
• Confirm with the claimant that they have no outstanding issues.
• Confirm the date on which all their entitlements will cease.
• If appropriate, provide the claimant with injury prevention information and
techniques.
• Confirm that they know what other entitlements they could be eligible for, such
as an independence allowance.
Procedure: Exit claimant
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Complete this procedure within five days of determining that the claimant has achieved
the outcome.
1. Conduct an exit interview with the claimant (and other parties as necessary).
1. Summarise the exit interview in the activity log in Pathway.
2. Record the actual completion date in the IRP tab (or CIS tab) in the Management
Notebook on Pathway.
3. Enter a Task on Pathway for a follow-up evaluation in 28 days, to make sure the
outcome has proved to be sustainable.
4. Write to notify the claimant's GP, their employer, and if applicable, the insurer, that
the rehabilitation is complete.
5. If the outcome is to acquire a capacity for work, initiate a WCAps.
6. When the Task on Pathway generates, carry out a follow-up evaluation. Has the
outcome proved to be durable?
• If yes, no further action is needed.
• If no, reconsider the claimant's need for further rehabllltatlon''.
5 This is detailed in full with the information about rehabilitation tools.
6 As described when reconsidering the outcome and the IRP.
Summary of rehabilitation tools
When to use the rehabilitation tools
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The managed rehabilitation process is supported by a number of tools and approaches.
Use these in the following situations:
Tool
..... >............ .>: ...•'.' .'',,···iiii:/>'I:,. ,x"i::.>,,;,,~~·i·.,ilx'f,.i";i.·' • >.... ..··>·i'·x:·> •.·•••·••'
.•.. /
•••• ...... ..••...........••.•,>: ••>.'>. .•••• >? r>y'YIII:,' i.W··:··.>.' ••.•• •.••.>•
Branch Medical Advisors (BMA's) - Ongoing.
supporting mechanism
Co-ordinated contracting - supporting Implementing the IRP.
mechanism
Decision-making tools: Deciding what interventions to provide.
• The Seven Questions
• The Test of Reasonableness
Duration management tools: • Determining the appropriate
MDA databases, including Read
case management stream.
•
Codes (previously known as • Setting outcomes and
Presley-Reed Duration Tables timeframes for interventions.
and Normative Review Point
Tables) • Monitoring and evaluating.
• Treatment Profiles
Individual Rehabilitation Plan (IRP) Ongoing - integral to every stage of
the rehabilitation process.
Quality Management File Review • Ongoing for normal
rehabilitation.
• Ongoing ad hoc, and as monthly
reviews, for serious injury.
IRAS • Setting timeframes for
interventions
• Monitoring and evaluating.
WeAP Exiting the claimant, when the outcome
is to "obtain employment" or "regain an
ability to work".
Duration management tools
About the duration management tools
This information relates to ACC's application of the AI Act 1998 and other previous
.Iegislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The two duration management tools are:
• Medical Disability Adviser (MDA) database
• Treatment Profiles
These tools provide you with:
• The likely types of medical treatment and other intervention they are likely to
need.
• The most likely timeframe in which you can expect the claimant to recover, if
they get those interventions.
Medical Disability Adviser (MDA) database
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use the MDA database when you are setting the expected outcome date, to find out:
• More about a claimant's injury or surgical procedure.
• Their likely incapacity duration.
Description
This tool is available as an application on the computer system. You access this
application, and use ICD9 Codes or various key words to search for the information you
want, either:
• A type of injury
• A type of medical procedure to remedy an injury
The database contains information about almost 5,000 different injuries, illnesses and
surgical procedures. Each MDA entry is listed by the ICD9 Code for the particular injury
or procedure it concerns.
Each entry includes a range of information about the injury or procedure, including:
• Options for treatment
• Incapacity durations
• Factors that will influence the claimant's recovery.
The recovery times that the database lists, for each type of injury or procedure, are
shown for each type of work.
Also, for each work type, it shows three durations:
• Minimum
• Optimum
• Maximum
Note:
These durations also display in Pathway, once you've entered an ICD9 and Work Type
in the Basic Claim Details screen, for a particular claimant.

Treatment Profiles
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Description
The Treatment Profiles are a collection of injury profiles that have been developed to
provide GPs with standardised expectations about treatment and incapacity. These are
published in a paper format.
Treatment Profiles include information on the injury, such as:
• What treatment is appropriate
• Probable duration of the incapacity
• Probable duration of the treatment
• Possible complications
• (For fractures) Illustration of the relevant injury site.
Treatment Profiles are free to GPs, although they are allowed only one each. If a GP
doesn't have one, CM's can order copies from Wickliffe Press for them,
on 0800 802 444. Other interested parties can purchase the Treatment Profiles from
Healthwise.
How they were developed
A group of NZ Independent Practitioner Associations identified the most common
- primary care injuries, and developed information about these.
They finalised this information in consultation with a wide group of health professionals
(including NZMA), incorporating incapacity durations from the Medical Disability Adviser
(MDA) database.
When to use
GPs should use this tool to:
• determine appropriate treatment for an injury
• certify time of incapacity, factoring in their clinical judgement
• make referrals
• monitor progress of patients against expected outcomes
Case Managers should use this tool to:
• Familiarise themselves with the information referenced by a GP before
contacting the GP regarding a particular claim.
• Ensure the levels of care are appropriate, and encourage quality outcomes.
How to use
The Treatment Profiles are grouped by injury type, e.g. Fractures and Dislocations,
Burns. Within these groupings the profiles are referenced by the Read Code for the
injury. The incapacity durations for each injury are included in a Summary section at
the front.
Definitions of injury codes
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
You use injury codes to record the specific injury or injuries the claimant has suffered.
Read Code
These are alphanurnerlc codes for a wide range of injuries, surgical procedures and
illnesses. Use Read Codes to record the following on Pathway:
• Claimant's injury, in the Basic Case Details screen.
• Any surgical procedure the claimant has undergone, in the RIF screen.
The coding system is organised in a hierarchy, so that each additional number or letter
defines the injury in more detail.
\) "S22.. " is the Read Code for a fractured humerus.
\) "S2241" is the Read Code for a closed fracture of the distal humerus.
Each code is made up of five characters. Codes with less than five number or letter are
made up to five digits using dots (full stops). The codes are also case sensitive. That
is, "s22.. " has a different meaning from "S22.. ".
ICD9 Code
These are codes in the ninth version of the International Classification of Diseases
(ICD). This is a system of coding injuries, surgical procedures and illnesses. Hospitals
often use this, or the later version ICD10.
ICD9 Codes are used to drive the MDA application. For this reason, Pathway translates
the Read Codes you record there into the relevant ICD9 Codes. If needed, you can use
an ICD9 Codes to specify the injury or surgery in Pathway, instead of a Read Code, but
we prefer Read Codes because they are usually more specific.
The system is numerical. The codes are made up of three digits, a decimal point, then
up to two further digits, such as "812.4". Injuries are grouped within the coding
system. For instance, all the codes between '800' and '820' are fractures. There must
be three digits before the decimal point, for example, you would use "081.1", not
"81.1". The further two digits, after the decimal point, each provide a more precise
definition, in a strict hierarchy. For example:
'" "812" is the ICD9 Code for a fracture of the humerus.
'" "812.4" is the ICD9 Code for a fracture of distal humerus.
\) "812.41" is the ICD9 Code for a closed fracture of the distal humerus.
Definitions of work types
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
In Pathway, you need to select the appropriate work type, for the type of work the
claimant will do after they recover. This can adjust the calculation of the duration. It's
based on the amount of force the claimant had to exert to carry out tasks.
Sedentary
Light
Negligible
Negligible
Negligible
Up to 10 pounds
Up to 10 pounds
Up to 20 pounds
Medium Up to 10 pounds Up to 20 pounds Up to 50 pounds
Heavy Up to 20 pounds Up to 50 pounds Up to 100 pounds
Very Heavy More than 20 pounds More than 50 pounds More than 100
pounds
Notes:
• If most tasks are within one work type, but one or more tasks exceed these
criteria, select the heavier work type.
• Sedentary work mostly involves sitting, but can include walking or standing for
brief periods.
• Light work usually requires significant walking or standing. However, if the
worker sits most of the time, but using arm and/or leg controls require more
exertion than for sedentary work, rate the job as light work.
• The MDA database refers to this as "job classification."
Definitions of duration types
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
MDA Optimum Duration
This is the period in which most claimants are likely to be able to return to work if:
• Their provider gives them optimal management
• They don't have any significant complications or co-morbid medical conditions.
i\J1DA Minimum Duration
This is the minimum recovery time that most claimants require to return to work at the
same performance level as prior to their injury.
In some cases, a claimant can medically return to work in less time, if they have, for
instance:
• Job accommodations from the employer.
• Medical supervision.
• Availability of light duty assignment.
• Company policies and practices that support their recovery.
MDA Maximum Duration
For cases that have significant complications, the end of this duration is the point where
you need to evaluate the claimant's progress, and possibly reconsider or reassess the
rehabilitation we're providing.
Many such cases could be expected to have returned to work within the Maximum
duration, but it's not a definitive end point.
Duration management tools (injuries with no MDA
durations)
Overview
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The durations in this document relate to injuries that:
• Aren't in the MDA database.
• Don't have durations listed in the MDA database.
If you can't find an Injury in the MDA database, before you contact your SMA, or call
the Rehabilitation HELP Desk, check here to see if the injury you are looking for is
listed.
These durations were developed by the Corporate Medical Adviser (CMA).
Burns (this will be completed later)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Contusions and crush injuries (this will be completed
later)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Fractures
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts
......... ..reX 2221·S"'''''' scs,.' "~~..< ·.-"i:j·;·s.~·:·,!im ,..... ,.
Inju ......... Xi.·;·... 1"1::;·•.· .. ·.•..·.• 1·.·.,; s.·.....-:..·••,. "i ....•• .,·C·.·.,·.... ·.. ,7.10.;·/,..·..•·.;'.7.·'•••,. ••• . )i)·).
Closed fracture of the skull 5040z 804.0 Fracture of the
skull
Fracture of shaft of radius 5239. 813.8
1
Fractured humerus 5226. 812.4 This is the
closest duration
Thumb closed traumatic 54DO 830
sublaxation MPjoint 1
Gradual onset (this will be completed later)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
lacerations and abrasions
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts
.......... >n<{ii. ;: ............... I;·;.·········> i~X;·~~.;:: It':..,>i•.•. , .....~..•...;:.,.:tip Inju .f ,.ii. ....~.~,.,f r:aL;U'::#.>.•.• ·.·i·.· :,..,.r;-:'.; •.•·.IHfcl.r<:i; li::-:::•J•";J.;I,.lt•••. P:,:j>.····':'";·.i'j';,"·l
Lacerated liver 56 224 Using
comparison
with repair of
I Aortic
Aneurysm
Lacerations 870- All lacerations
897
! Open wounds 870- All open
897 wounds not
specifica Ily
mentioned in
MDA
Surgical procedures
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts
:nj'lry
..............; ....... ·.·.:·R’A·rAi I.·.... ;•.• i ..·. Il·~ig.;i;i.1'8·....·2'.:I··m.',:.: I:";:;';. ,. "i·. ..........
'.1'-1" ~VII;'.111 c,,~f··.·.··.·••• ...ii· .. .· ..7:'~i·· ...... -: ....... .... .... I.i
Tibialis Posterior Transfer 823 Use the ICD9
code for
Fracture Fibula
open with
internal fixation
(823)
Tendon Reconstruction - 823 Same as above
ankle
Thoracic outlet release 353.0 Surgical
treatment
(scalenectomy)
High tibial osteotomy 823 Use code for
fractured
tibia/fibula
Repair recurrent 836.3 Duration option
dislocating patella for surgical
treatment of
recurrent
Sprains
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under Rrevious acts
....... </« iX1T8> iRcR~/< .'."~} .c".......// ..........«/.
Injury ........ !> I>
.\'
...... >', }·cc." • 0 ".:~< .·<0r:".~'\ y '9]<,..·.·. \.;-1.J"~"'711 L::> •..•• .'.<.
Anterior shin splints SKOy5 958.8 Shin splints
normally give
rise to no
incapacity.
Reference here
is for
compartment
syndrome
which could be
considered
appropriate for
severe cases.
Coccyx sprain Pending
I
Complete tear, knee Pending
ligament
-.
I Hand and wrist flexor N264 82.41 This gives
tendon rupture duration for
repair of the
tendons.
Shoulder sprain S50.. 840
Sacroilliac sprain lower 847.9
back/spine
Traumatic amputations
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under Rrevious acts.
Inj
Amputated finger 7L052 84.01
Amputation of little finger S96..
with infection
Amputation of thumb tip S9505
S9506
Miscellaneous
84.01
+
136.9
84.01
Amputation
With infection
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under Rrevious acts.
Ity .......
.......>pi!/2i •<)<i i.; .·.i)§'2~I... ..,,",~ ..............!! II" vli.....<i......·~0i·;.·).W/\liii.lm
Acute radiation H4yOO 480
pnuemonitis
Cervical spinal stenosis N130. 724.0
Gastrocnemus tear S5VO 845.0 Ruptured
Achilles Tendon
Injury of radial artery at Pending
wrist and hand level
Occupational respiratory Pending
difficulties
Post knee replacement 81.54 Use knee
with femoral nerve palsy + replacement
957.9 plus nerve
injury
Prepatella Bursitis N2165 727.3 Bursitis
Radial nerve injury Pending
Removal of foreign body 7H567 Can use muscle
from muscle injury for
managing
claimant to
duration (IRP)
- however this
does not have
an ICD9 code
currently. This
is being looked
at.
Trochanteric Bursitis N2157 727.5
Trophic leg ulcer Pending
Ulnar nerve entrapment 957.9
Foreign body- in joint 717.6
Torn tirangular fibro 813.4 In duration
cartilage choose ulnar
Ulnocarpal impingement 813.4 Same as above
Pa in Synd rome 337.2 Complex
regional pain
syndrome -
check that this
fits the specific
pain problem
Calcific Tendontis N23y9 726.9 Choose
Tendintis as the
option
Supporting mechanisms
Mechanisms to support rehabilitation case management
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Branch medical advisors (BMA's)
SMA's are staff with extensive medical experience. They support the rehabilitation
process by providing branches with the following services:
• Case management support and education.
• Providing opinions beyond the immediately obvious.
• Preventing cases from escalating to long term, by identifying pre-existing
conditions or other medical related issues.
• Identifying factors that are contributing to on-going entitlement, and the cause
of on-going incapacity.
• Providing medical opinions on claims that are being forwarded for review and
appeal.
• Providing education, feedback and relationship management of external
providers, including GPs.
• Providing advice about to decisions on cover for gradual process claims.
• Providing a quality check for entry to WRAP, and provldlnq decisions on exltlnq
claimants through WRAP.
Co-ordinated contracting
This will be completed later.
Work rehabilitation assessment 1 Determine
eligibility
About work rehabilitation assessments
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Work rehabilitation assessments (also known as the "WRAP" process) are a tool for case
managers to use to determine whether or not a claimant has regained a capacity to
work following the completion of their vocational rehabilitation programme.
Different policies apply
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The procedure prior to 15 January 2001, was known as work capacity assessment
(WCAP) and determined whether or not a claimant had regained a capacity to work for
30 hours or more per week followlnq the completion of their vocational rehabilitation
programme.
From 15 January 2001, the work rehabilitation assessment process assists ACC to
determine whether the claimant is capable of 35 hours or more per week.
When to use the work rehabilitation assessment process
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The work rehabilitation assessment process applies to:
• All new claimants having an initial interview advising of the commencement of
the work rehabilitation assessment process on or after 15 January 2001.
• All claimants requiring reassessment of their capacity for work, following a
possible deterioration, on or after 15 January 2001.
Use the work rehabilitation assessment process to assess a claimant's capacity for work
when:
• The claimant's medical treatment needs have been fully met.
a The vocational rehabilitation programme has been completed.
• They are receiving full or abated weekly compensation.
There are two main parts to the work rehabilitation assessment:
a Occupational assessment, and
• Medical assessment.
Occupational assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The occupational assessment focuses on the claimant's ability to undertake employment
options, based on their:
• Experience
• Education
• Training
• Transferable skills
• Any combination of the above
This assessment provides ACC with an ACC1951 report, which prioritises all of the
claimant's employment options. The occupational assessor also provides a separate
ACC1962 sheet for each job option identified. P.C:~lJ.p.?t!9.I}-,?.L?.~~~.~.~9.r~d!!th9.~gh.D9.L... .... ·····f Deleted: ~
r-equired to take into account the local labour market, are required to identify jobs that '------"-----~
are fair and reasonable and reflect actual jobs in the labour market.
If the occupational assessor believes there has been insufficient vocational rehabilitation
to ensure the claimant has a capacity to work, then they:
• Contact the case manager to discuss their concerns.
• Complete the ACC195 providing options for further vocational rehabilitation.
Medical assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The medical assessment considers the effects of all the claimant's injuries for which
there's an accepted claim, in relation to the identified employment options, and
recommends whether the claimant has a capacity for work.
If the medical assessor needs further information or an additional assessment:
• The medical assessor contacts the case manager.
• The medical assessor provides the specific information or questions they would
like answered.
• The case manager organises the assessment and forwards the report to them.
• The medical assessor then uses the further information, together with a further
discussion with the claimant, to complete their report and recommendations
concerning the claimant's capacity for work.
The medical assessor will need to identify whether the claimant can work 30 hours per
week, and 35 hours per week.
Note:
The legislation currently is 30 hours per week and the proposed legislation is 35 hours.
By commencing 35 hours for all new claimants from 15 January 2001 this will assist
with the transition to the new legislation.
0

#14 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 05:02 PM

Eligibility criteria
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1 Work rehabilitation assessment: Occupational assessment form .f Work rehabilitation assessment: Job details sheet
A claimant is only eligible for a work rehabilitation assessment if all of the following
criteria apply. Do not consider an assessment unless you are 100% confident that
these criteria can be met.
Use these criteria for acceptance into the work rehabilitation assessment process:
Vocational Rehabilitation
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
o The claimant has signed the Individual Rehabilitation Plan (IRP) and any
vocational rehabilitation for which ACC was liable has been completed within the
last 12 months.
o Suitable alternative occupation(s) were identified within the vocational
programme and evidence exists to demonstrate that the claimant has
participated in identifying occupational choices.
o The IRP includes specific interventions to assist the claimant to obtain
employment or become work ready in those alternative occupation(s) as
identified in the rehabilitation plan.
o All interventions or modified interventions on the rehabilitation plan have been
completed.
IVledical Rehabilitation
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
o There is no outstanding injury related medical treatment preventing a return to
work of 35 hours (30 hours for claimants who commenced the process prior to
15 January 2001) or more per week (for example, planned surgery) on any
claim for which the claimant has cover.
o Where a health professional indicates that pain is an issue, there is evidence on
the file that this has been addressed and managed within the context of the
occupation(s) identified in the vocational rehabilitation programme.
About the branch review team
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Who makes up the Review team
The Branch Review Team is made up of:
o The Branch Medical Advisor (BMA)
o A Team Manager
What the team does
o The team's job in relation to the work rehabilitation assessment is accountability
for ensuring claimants entering the process meet the stated criteria. (Please
note that the final accountability resides with the Team Manager.)
o Review claim file, specifically for completion of vocational rehabilitation and the
quality of the rehabilitation.
• Team Manager completes Section B of form ACC191A3
• BMA completes Section B of the ACC191A
• Final sign-off Section C of ACC191A
• Assists case manager with ongoing decision-making process
Note:
The review team is accountable for ensuring all claimants entering the work
rehabilitation assessment process meet the stated criteria in Section B of the ACC191A.
Procedure: Determine eligibility for work rehabilitation
assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use this procedure to determine whether a claimant receiving weekly compensation
should be referred for a work rehabilitation assessment, once rehabilitation is complete.
1. Make sure you have a current consent form ACC1674 from the claimant.
2. Print form ACC191A5 and complete the appropriate sections.
3. Complete Section A (File Summary) and Section B (Case Manager Check List) of the
ACC191A.
Note:
All criteria must be met before a claimant can progress into the work rehabilitation
process.
4. If your recommendation is not to refer the claimant for a work rehabilitation
assessment, continue case management until rehabilitation and treatment is
completed, and:
• Make sure that any additional rehabilitation or treatment has specific outcomes
and is time framed on the IRP.
• Set a milestone date to check the criteria again.
5. If your recommendation is to refer the claimant for a work rehabilitation
assessment, forward the claim file and the ACC191A to the Branch Review Team.
Tag the following:
• The IRP.
• The most recent medical certificate.
• All previous vocational assessments.
• Recent medical reports.
• Case notes showing the progress of rehabilitation.
• A copy of the claimant's curriculum vitae (if available).
6. If the claimant doesn't meet the team's criteria:
• Ask them to specify the case management needed.
• Set a review date to look at the possibility of a further work rehabilitation
3 Work rehabilitation assessment: File summary, team review and quality check
4 Claimant consent for the collection and release of information
5 Work rehabilitation assessment: File summary, team review and quality check
assessment.
7. If the claimant does meet the team's criteria, and the ACC191A is fully signed off
and dated, contact the claimant to arrange an interview.
8. All team members must sign the ACC191A before the claimant can be contacted to
commence the work rehabilitation assessment.
Work rehabilitation assessment 2 Arrange
assessment
Interviewing the claimant
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Arrange a face-to-face interview with the claimant following the review team sign-off on
the ACC191A1 form. This interview:
• Is your opportunity to explain the work rehabilitation assessment process to the
claimant, so that the claimant fully understands the assessment process and the
possible outcomes.
• Gives the claimant an opportunity to ask questions and discuss any concerns
they may have about the assessment process.
• Gives ACC the opportunity to let the claimant know what their responsibilities
are regarding the process.
Use the checklist later in this document to make sure you cover all the required points.
Note:
If the claimant refuses a face-to-face interview, write to the claimant and include all the
information in the letter that would be covered in the interview.
Clearly document their refusal in Pathway.
Interview checklist
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
In the interview, ensure the claimant has a copy of the Fact Sheet and discuss the
followlnq:
• Make sure the claimant understands that the vocational rehabilitation
programme is complete, and that assessing a claimant's capacity for work is a
continuum, following vocational rehabilitation.
• Outline the work rehabilitation assessment process specifically stating:
• The nature, purpose and outcome of the work rehabilitation assessment, that
is, the assessment could state that the person does not have a capacity for,
or that the person does have a capacity for work.
• That the claimant must participate in the assessment and the consequence of
not doing so (that their weekly compensation can be ceased under
Section 116).
• That the claimant can bring a support person with them during both
assessments.
• That if there are any special language, cultural or other needs these will be
taken into consideration.
• Explain that their weekly compensation will cease after three months if the
assessment finds they have a capacity to work.
• Explain that ACC is able to assist the claimant following completion of the work
1 Work rehabilitation assessment: File summary, team review and quality check
rehabilitation process and the determination of capacity for work by providing:
• A job search programme (which ACC will fund).
• Budgeting and counselling advice.
• Ongoing case management.
• Assistance to enrol with the Department of Work and Income.
• A list of employment agencies.
• Explain if they are found not to have a capacity for work rehabilitation and
weekly compensation will continue.
• Clearly distinguish and explain the roles of the occupational assessor (OA) and
medical assessor (MA).
• Explain that the OA assesses for ability, such as employment skills, not medical
capacity.
• Make them aware that the OA could recommend jobs that, medically, the
claimant can't perform, and that we will take that into account.
• Explain that the OA and MA, although contracted by ACC for their services, are
independent of ACC.
• Explain that if they need further treatment at any stage, the results of the work
rehabilitation assessment don't prevent further treatment. (The assessment
relates only to their entitlement to weekly compensation, not to medical cover.)
• Explain that we make the final decision on ceasing weekly compensation based
on information we receive from the assessors. The medical assessor will make a
recommendation regarding their capacity to work. The assessors are part of this
information gathering process, but they don't make the final decision.
• Explain to the claimant that, even if they're working but still receiving weekly
compensation, we can require them to undertake an assessment to determine
their capacity for work.
• Explain that the assessor doesn't just assess whether they can do their current
job, they assess their general capacity to work.
• Explain that if they don't have a capacity to work more than 35 hours a week,
the medical assessor will suggest further rehabilitation treatment.
• Advise the claimant that we can pay for transport costs to attend the
assessment for journeys of more than 20km. Advise that we will pay the lowest
public transport fare (or 57 cents a kilometre if there is no public transport) to
the nearest assessor.
• If the claimant needs overnight accommodation, we will pay $56.30 a night.
Recording the claimant interview
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Record the following details as the claimant interview progresses:
1. Give the claimant a copy of the following documents. Ask them to complete an
ACC1932 questionnaire, and sign that the information on the ACC191A3 is correct.
(If the claimant wishes to take the information away, this is acceptable. The
2 Work rehabilitation assessment: Claimant questionnaire
3 Work rehabilitation assessment: File summary, team review and quality check form
claimant mustn't feel any pressure to complete or sign any document until they've
had time to read the information.)
• Form ACC191A (All sections must be completed.)
• Form ACC191S4 (There's a section on this form for claimant comment.)
• Fact sheet FSWRA015
• Letter WRA026 (You can either give this to the claimant at the initial interview
or send it out after the interview with the ACC193.)
• Form ACC193
2. Make yourself available to record the claimant's comments, if they prefer this. If
the claimant doesn't wish to sign the ACC191A or complete ACC193 (Claimant
questionnaire) you must record this.
3. Inform the claimant that they can provide you further written comments later, and
that you'll forward their comments to the assessor(s), as long as they're received
before the assessments take place.
Arranging the assessments
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The assessor contacts the claimant to arrange assessments, within four working days of
receiving our referral. Whenever you refer a claimant whose history suggests that they
could pose a threat to the occupational assessor or medical assessor, or any other
assessor, please remember to provide appropriate advice to the assessors telling them
that their safety could be at risk.
The assessor:
• Makes an appointment with the claimant, and interviews them within ten
working days of making that appointment.
• Completes a report, including their recommendations, and forwards that to the
claimant and to ACC, within eight working days of the interview.
Note:
The timeframes the assessor must meet are detailed in their provider contract for their
services. All contracts require the same timeframes. (However, assessors can always
request an extension if circumstances outside their control prevent them meeting the
contracted timeframes.)
If claimant doesn't attend appointment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Sometimes the appointment between the claimant and the assessor can't or doesn't
happen as planned:
• If the assessor can't contact the claimant, or is unable to do an assessment, the
assessor should let us know within five working days, so that we can arrange
another assessor to see the claimant.
4 Work rehabilitation assessment: Claimant quality check
5 Work rehabilitation assessment
6 Claimant notification of occupational assessment
• If a claimant can't attend their appointment, they should give the assessor at
least one day's notice so they can arrange another appointment time.
• If the claimant doesn't attend their appointment, the assessor contacts the case
manager, who asks for two further appointment times. It is then the case
manager's responsibility to arrange the further appointment with the claimant,
and let them know what their responsibilities are regarding attending the
assessment.
• The assessor(s) should provide us with a written record of any non-attendance.
Checklist for the occupational assessment
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Send the following information to the occupational assessor (OA):
• Letter WRA037 as the covering letter.
• A copy of the claimant's individual rehabilitation plan.
• Case notes showing the progress of the claimant's rehabilitation, including
vocational assessments.
• A copy of forms ACC191A8 and ACC191B9
•
• Form ACC1971O
•
• A copy of the claimant's curriculum vitae.
Checklist for the medical assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Send the following information to the medical assessor (MA):
• Letter WRA0411 as the covering letter
• A complete list of all the documents you're sending
• Completed ACC191A12 form
• Completed ACC191B13 form
• Completed ACC19214 form
• Completed ACC19315 form (if claimant completed it)
7 Referral for occupational assessor
8 Work rehabilitation assessment: File summary, team review and quality check form
9 Work rehabilitation assessment: Claimant quality check
10 Work rehabilitation assessment: Recommendation
11 Referral for medical assessor
12 Work rehabilitation assessment: File summary, team review and quality check form
13 Work rehabilitation assessment: Claimant quality check
14 List of referral documents for the work rehabilitation medical assessor
• Completed ACC19416 form (see Note)
• Completed ACC19S17 form from the Occupational Assessor (OA)
• All completed ACC19618 forms from the OA
• Form ACC19719 with initial section completed by OA
• Completed ACC16720 consent form
• A copy of the most up-to-date vocational individual rehabilitation plan (IRP).
• Copies of all medical specialist and radiological reports received before the IRP
was prepared even if medical reports do not relate to current injury.
• Copies of all medical and specialist and radiological reports received during
rehabilitation.
• Copies of all relevant physiotherapy and pain management reports
• A copy of original 'advice of injury' form (to establish cover)
• A copy of the latest ACC18 certificate of incapacity
Note:
The GP is obliged to complete the ACC194. If the GP doesn't complete and return this
within ten days of your request, and you haven't succeeded in contacting them, then
note in the covering letter that this questionnaire hasn't been completed, and proceed
as normal.
Assessment fees (occupational and medical)
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
All contracted assessors provide their services for the fees shown in this table.
Medical or occupational assessment
If the assessor recommends further rehabilitation for the
claimant, medical reassessment (after that rehabilitation)
Non attendance fee (where a claimant fails to attend a
scheduled appointment with the assessor) is payable once
per claimant
In negotiation with the case manager, for assessors to hire
rooms to undertake assessments
Note:
Assessments mustn't take place in a claimant's home or an
ACC office.
Transport costs
$390 + GST
$200 + GST
Fixed rate of $60 +
GST
Up to $100 per day
15 Work rehabilitation assessment: Claimant questionnaire
16 Work rehabilitation assessment: General practitioner questionnaire
17 Occupational assessment form
18 Job details sheet
19 Work rehabilitation assessment: Recommendation
20 Claimant consent for collection and release of information
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Reimburse mileage for uninterrupted journeys of more than 20km at the rate of $0.62
cents per km, plus GST.
Travelling time won't be paid for.
If the medical assessor has an overnight stay, accommodation and evening meal will be
paid by ACC.
Procedure: Arrange work rehabilitation assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Use this procedure once the review team has completed and signed off the ACC191A21
form.
1. Arrange and carry out an interview with the claimant.
2. At the interview give the claimant a copy of the documents described earlier in this
document.
3. Send letter WRA0222 to the claimant, confirming that the work rehabilitation
assessment process will commence and an occupational assessor and a medical
assessor will contact them to arrange an appointment for an assessment.
(Alternatively, you can give this letter to the claimant at the interview.)
4. Send form ACC19323 to the claimant to complete and return. (The claimant is
encouraged to complete thls.)
5. Send letter WRA0124 with an ACC19425 form to the claimant's GP.
If the GP doesn't return this form to you within 10 days, ring the GP and state the
value of this information for the claimant. Ask GPto complete it within five days. If
you still don't receive the information, proceed as normal and record that the GP
questionnaire wasn't returned.
6. Send letter WRA0326 to the occupational assessor (OA).
The OA should arrange the assessment with the claimant, but this can depend on
branch practice.
7. Once you receive the OA's report, send letter WRA0427 to the medical assessor (MA)
with the list of information described earlier in this document.
The MA should arrange the assessment appointment with the claimant, but this can
depend on branch practice. The MA sends the completed report to the claimant and
to you.
8. Complete the procedure for actioning the assessors' recommendations.
21 Work rehabilitation assessment: File summary, team review and quality check
22 Claimant notification of occupational assessment
23 Work rehabilitation assessment: Claimant questionnaire
24 Work rehabilitation assessment: General practitioner questionnaire
25 Work rehabilitation assessment: General practitioner questionnaire
26 Referral for occupational assessor
27 Referral for medical assessor
Work rehabilitation assessment3-Action
recommendations
Actioning assessment recommendations
Deciding on the result
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Once the work rehabilitation assessments are complete, the case manager and the
review team (team manager and BMA) discuss the information provided by the
assessors.
The team needs to agree on whether the claimant has a capacity to work for 35 hours
or more per week, and what action ACC will take on that basis.
The team will have recommendations from the medical assessor stating whether the
claimant can work 30 hours and 35 hours per week.
If there are no jobs that reach the 35 hours or more per week capacity, do not issue a
decision that the claimant has a capacity for work but arrange for further rehabilitation
or treatment before being reassessed.
Note:
The medical assessor only needs to recommend one job over 35 hours or more per
week.
Completing the quality check
This information relates to ACe's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The ACC1981 form gives the process for a comprehensive quality check:
• Team manager completes the team manager checklist. (All boxes must be
ticked)
• BMA completes the Branch Medical Advisor checklist. (All boxes must be tlcked.)
• Both team manager and BMA complete the "Review Team" decision section, and
sign that either:
• They both agree the claimant has a capacity for work, or
• There are further medical or vocational issues that need to be addressed.
Note:
It's crucial to consider each part and address any inconsistencies or information gaps
before making a final decision.
What to do if the occupational or medical assessor
recommends further rehabilitation or treatment:
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1. Obtain specific information from the assessor.
1 Work rehabilitation assessment: Final quality check and decision
2. Update the claimant's IRP.
3. Complete any further agreed interventions.
4. Restart the work rehabilitation assessment process.
Ceasing entitlement
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant has regained a capacity for work, they lose their entitlement to weekly
compensation three months from the date on which they were notified in writing of the
decision.
During this period, you need to:
• Ensure you have regular contact with the claimant during the 3 month period (at
least once every four weeks)
• Offer the claimant a copy of the about employment agencies fact sheet
FSWRA022 together with the corresponding list of employment agencies in their
area. (A full list of agencies is available in the list of rehabilitation forms, letters,
fact sheets by category.)
• Offer the claimant Transitional Job Search assistance. This is a contracted
programme for people with a capacity for work who have not found employment.
This programme is not:
• Vocational rehabilitation, or
• A component of the IRP.
• Budgeting and counselling assistance. This can be up to a maximum of two
sessions for each of:
• Budgetary advice through a budgetary advlsorv agency (Citizens Advice
Agency).
• Counselling (use ACC registered counsellors found elsewhere in Informe).
• Enrolment with the Department of Work and Income
Note:
The programme must not extend beyond the final weekly compensation cessation
date.
Transitional Job Search service
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
The Transitional Job Search service is designed to place the claimant into paid,
permanent and continuous employment that meets the required hours or days to be
worked.
The purpose of purchasing this service is:
• To provide additional assistance to claimants who are looking for work after a
decision is made that they have a capacity for work.
• To improve ACC's commitment to supporting claimants follOWing the work
2 About employment agencies
rehabilitation assessment process.
• To improve the outcome of a decision of the capacity of work by providing
additional job search assistance.
• To provide the claimant with an opportunity to find work through a process not
associated with vocational rehabilitation but as an additional support service
• To support the claimant with CV updates and pre employment preparation
(optional extra).
• To provide the case manager with access to high quality standardised
transitional job search services which are cost-effective, provided in a safe
environment, and delivered in a timely manner.
• To provide case managers with a service that they can offer claimants who are
not in employment and have been issued with a decision that their entitlment to
ongoing weekly compensation will cease within a defined period.
• To match claimant capabilities to suitable identified employment opportunities
(this means the jobs that were identified in the work rehabilitation assessment)
• To improve the ability of the claimant to seek and secure suitable employment.
Core components of the service
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
• Plan of action.
• CV preparation or modification if current CV does not meet the requirements of
the jobs identified by the occupational assessor.
• Clarification of job options and agreed vocational directions.
• Job search services. (Including information on job search strategies, close
monitoring in job seeking of no less than one hour every 2 weeks, and
achievement of a job placement.)
Optional components of the service
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Preparation for job seeking including:
• Mandatory components.
• Labour market information.
• Interview skills.
• Job search strategies.
• GUidance on personal presentation.
• Discretionary components:
• Guidance on self motivation, stress management and time management.
• Advfce on punctuality and employer expectations.
Process: Transitional Job Search
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1. The case manager discusses the decision with the claimant and offers to refer the
claimant for transitional job search.
2. If the claimant accepts the offer of, Transitional Job Search, the case manager
makes a referral using ACC21S3 to a contracted agency.
The referral includes:
• The optional service components required.
II A list of the claimant's job options.
• Specific relevant information relating to the claimant's injury and any
restrictions.
II Specific relevant information relating to the claimant's employment history.
• Previous relevant rehabilitation interventions including copies of relevant reports
and assessments.
• Any known barriers to the claimant's return to work.
II The service period (which can be for up to 10 weeks but must not extend
beyond the claimant's weekly compensation cessation date).
3. The case manager sends letter VR024 to the claimant notifying them of the
programme objectives, the providers name and address, the proposed commencing
date and that the provider will be in contact with them to make the necessary
arrangements.
4. Within 2 working days of provider receiving referral, the provider will notify the case
manager of their acceptance.
5. Within 7 working days of accepting the referral, the provider commences the
service.
The provider will notify the case manager within 3 days of receiving the referral of
any inability to contact the claimant.
6. The provider will send brief monthly progress reports to the case manager.
7. On completion of the service the provider sends a final completion report, a copy of
the claimants updated CV and an invoice to the case manager.
The completion report must contain the following information:
• Whether a return to work outcome has been achieved and if so employer details.
II Services completed.
• Goals achieved.
• Obstacles encountered.
• Other relevant information.
fees payable
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Refer to the relevant contracted provider list in Informe for fees payable for these
services.
3 Referral for Transitional Job Search services
4 Claimant advice of job search appointment
The chargeable services are:
• Plan of action.
• CV preparation or modification.
• Preparation for job search.
• Job search services. (This service component is paid on an hourly basis up to a
maximum of 12 hours and is invoiced monthly with the progress report.)
Weekly compensation payments during job search
period
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Entitlement to weekly compensation payments continues as usual throughout the work
rehabilitation assessment process, up to the end of the three-month period. You need
to:
• Continue payments until that date.
• IMPORTANT! Change the account code to the correct payment code for a work
capacity job search allowance.
• If the claimant applies to the Department of Work and Income provide them with
their weekly compensation entitlement details, for the Department of Work and
Income's use.
Abate the claimant's payments as appropriate during the remainder of the period if:
• They continue to work, or get work during the period, and
• Their earnings are less than the weekly compensation payments.
Note:
The claimant doesn't need to provide any medical certificates during this period.
Review of work rehabilitation assessment
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Our primary focus must be ensuring that, if a claimant seeks a review, we've applied
the work rehabilitation assessment process fairly and reasonably. This can be achieved
through:
• Sound case management practice, and open and honest communication with
claimants.
• Completion of a vocational rehabilitation programme.
• Adhering strictly to all the steps of the work rehabilitation assessment process.
• Addressing any concerns raised by the claimant (or their support person) at the
time they are raised.
• FollOWing up on any inconsistencies or information gaps provided by assessors.
If a claimant goes to review follow the administration review process:
• Participate in the review hearing
• Apply for legal assistance from ACC Legal Services if the review is potentially
difficult and high risk (only).
(Assistance will be granted in exceptional circumstances, if the issues are
contentious, or the claimant and their advocate are particularly challenging.)
Reporting
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Reporting will occur through Pathway data on a monthly basis, with the reporting
information being aggregated in Corporate Office and available to the Network.
Therefore, it's imperative that case managers use the Management Notebook to record
claimants going through the work rehabilitation assessment process.
The Management Notebook:
• Produces all letters; and
• Enables you to make all entries there (so you don't need to use the Activity
Log).
Auditing
Random audits of occupational and medical assessors' reports will occur quarterly.
Special cases
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
~ Deterioration following a determination of a capacity for work
e Major complications following surgery
.. Claimant does not have a capacity to work
Deterioration following a determination of a capacity for
work
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Following ACC's decision that a claimant has a capacity to work, the claimant's injury
status may deteriorate.
Two common examples of deterioration following the work rehabilitation assessment
decision:
• Recurrence or deterioration of the injuries for which the claimant has cover.
• Requests for further treatment (such as surgery).
Recurrences and/or deterioration
If the claimant produces a medical certificate indicating a recurrence or deterioration:
• Contact the GP and ask if, in their opinion, the recurrence or deterioration
affects the claimant's capacity to perform the jobs identified in the work
rehabilitation assessment.
If the GP states this is the case, arrange for the claimant to undergo a further work
rehabilitation occupational and medical assessment to verify this.
It is recommended that you ask the GP for a written report and ask them to specify the
following:
• Is this episode of incapacity directly related to an existing injury for which the
claimant has cover, or
• Is it a new injury?
• What has caused the recurrence or deterioration?
• When did it happen? (the actual date)
• How did the recurrence/deterioration occur? (what aggravated the existing
injury?)
• How long is the period of incapacity expected to last? (date to be included)
• What rehabilitation/treatment is being instigated and/or undertaken by the GP?
Do not reinstate weekly compensation until it has been determined that a claimant no
longer has a capacity for work. Under no circumstances must weekly compensation be
reinstated until a further occupational and medical assessment determines an
incapacity for work.
Note:
If a claimant requires a work rehabilitation medical assessment, they must reach the 35
hours per week threshold.
If it is determined that they have an incapacity, back date weekly compensation from
the date on the medical certificate.
Earnerss requiring surgery after a WRAP decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant has returned to work after a Work Rehabilitation Assessment Process
(WRAP) decision has been made, but requires surgery that may affect their capacity to
work, weekly compensation is as follows:
Rate of weekly compensation for time off work
A claimant may need time off work due to injury-related surgery. This is related to the
claim on which a WRAP decision has been made.
In this case the claimant is entitled to weekly compensation with entitlement calculated
on earnings immediately prior to the date of surgery.
Weekly compensation entitlement
The weekly compensation entitlement is limited to the period of the expected date of
recovery from surgery as specified by the Medical Disability Advisor (MDA) gUidelines.
Where there are no MDA quldellnes for the particular surgery weekly compensation is
limited to the expected recovery date specified by the surgeon. Obtain this date prior
to surgery.
Note:
The Elective Surgery Unit (ESU) advises the claimant to contact their case manager,
who advises them as to whether they have an entitlement to weekly compensation.
Return to work.
No weekly compensation entitlement is payable after the pre-determined recovery date.
5 This is not applicable for claimants who need surgery and are
non- earners.
Advise the claimant that they will be expected to return to work following the expected
recovery date.
Claimant's capacity for work deteriorates
If the claimant advises that their capacity for work has deteriorated after the expected
recovery date, weekly compensation does not continue under this policy.
Refer the claimant to the WRAP process to determine if the person is eligible for weekly
compensation on the basis of a deterioration.
Major complications following surgery
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If there is a major complication following surgery, the claimant or their representative
needs to notify the case manager.
The case manager and the Branch Medical Advisor (BMA) will discuss the ongoing
incapacity with the surgeon to establish a new date for ceasing weekly compensation
payments.
If, by this new date, the claimant has still not returned to work they will be required to
undergo a work rehabilitation assessment.
Note:
The above policy relates only to claimants who have returned to work following the
Work Rehabilitation Assessment Process (WRAP).
Claimant does not have a capacity to work
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant does not recover within the expected surgery recovery time, they may
require a Work Rehabilitation Assessment Process (WRAP) assessment.
If the WRAP assessment shows the claimant is unable to perform any jobs specified in
the occupational assessment they:
• Are entitled to weekly compensation payments if they are an earner and
otherwise eligible, and
• Can undertake any further treatment and/or rehabilitation for which they are
eligible, and
• Can proceed through the WRAP process again following the completion of any
agreed further vocational rehabilitation.
Note:
If the claimant requires surgery before the completion of the WRAP this could mean
treatment needs have not been fully met and the WRAP might need to be deferred. In
this case seek advice from your BMA.
Weekly compensation entitlement for further incapacity
If the claimant's condition deteriorates and they need treatment other than surgery
complete a further WRAP.
If this shows the claimant is not able to work they are entitled to weekly compensation
as follows:
The claimant receives the greater of the following:
• The rate of weekly compensation they were last entitled to (updated for
indexation if applicable).
• The recalculated rate based on their actual recent earnings.
This means that even if the claimant becomes entitled to weekly compensation again,
but no longer has a job, they can still retain their previous entitlement.
Procedure: Review assessment reports
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1. When the occupational assessment report arrives:
• Review the documents for accuracy and completeness.
• If anything is unclear request further clarification from the occupational assessor
before proceeding with the medical assessment.
The occupational assessor may discuss or note in their report vocational
rehabilitation gaps. You need to determine whether the gaps preclude the claimant
going onto a medical assessment or whether further explanation is required to the
occupational assessor.
Note:
The occupational assessor must have sent the following copies on completing their
assessment:
• To the claimant, a copy of their assessment on forms ACC19S6 and ACC1967
•
• To the case manager, the assessment forms as above, plus a copy of the
ACC1978
•
2, When the medical assessment arrives, discuss the reports with the review team:
• The medical assessor must send a copy of their assessment report to the
claimant on completing their assessment.
• If you find inconsistencies in the medical assessor's report (such as lack of
clarity, typos, and so on) ask the medical assessor to correct these and to send
an updated copy to the claimant.
3. The team manager and the branch medical advisor must complete the ACC1989 (as
described earlier) before the case manager notifies the claimant.
Note:
All sections must be completed.
4, Once the team reaches a decision, arrange an interview with the claimant, to
discuss the results of the assessments.
Note:
The claimant needs to be encouraged to come into the office and discuss the
outcomes from the work rehabilitation assessments.
If the claimant doesn't wish to come in for an interview, this can take place over the
phone. (Record that the claimant has chosen this option.)
Procedure: Interview claimant and action
recommendations
6 Occupational assessment form
7 Work rehabilitation assessment: Job details sheet
8 Work rehabilitation assessment: Recommendation
9 Work rehabilitation assessment: Final quality check and decision
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
1. In the interview, advise the claimant of all the following points and ensure they fully
understand:
• They have received copies of the occupational and medical assessments.
• The outcome of the assessments.
• The recommendations the assessors made.
• The review team's decision.
• How these decisions affect the claimant.
• Ongoing access to the issues discussed earlier in this document
• Their ongoing access to medical treatment is available if required.
• The review process, and their right to review.
2. If the team's decision is to continue rehabilitation:
• Discuss with the claimant what further rehabilitation will be provided.
• Obtain their agreement and signature on the extended IRP to further
assessments needed, and so on.
3. If the team's decision is that the claimant has regained their capacity to work,
explain to the claimant at the interview that:
• Their entitlement to vocational rehabilitation ceases.
• Any entitlement they have to weekly compensation will cease three months from
the date you advise the decision in writing.
• We will provide ongoing support during this period (as per Step 1 above).
• Explain that ACC will assist by providing:
• Job search assistance. (Transitional Job Search Service)
• Budgeting and counselling advice.
• Regular contact with a case manager. (Monthly)
• Assistance to enrol with the Department of Work and Income.
• A list of employment agencies.
4. If the team's decision is that the claimant is unable to work because of non-injury
related factors, but their medical condition doesn't preclude them from performing
job(s) identified by the occupational assessor, proceed as per Step 3 above.
5. If the claimant has regained a capacity to work, and weekly compensation is to
cease:
• Continue weekly compensation payments in IIS until the end of the three-month
period.
• If the claimant gets a job during this period, abate their weekly compensation
payments as normal.
6. After the interview, confirm what you've discussed in writing, using the appropriate
letter:
• Letter WRA061O
, if the claimant has regained a capacity to work, and was
10 Claimant notification of compensation cessation
receiving weekly compensation.
• Letter WRA0711
, if rehabilitation is to continue.
7. If you're sending letter WRA06 to the claimant, also:
• Include a copy of the leaflet "Is There a Problem" with the letter.
• Photocopy the WRA06 letter. Sign on this copy that you've enclosed the leaflet,
and retain this copy on the claimant's file.
• Send letter WRAOS12 to the claimant's GP and ensure you attach the medical
assessor's report to it.
S. If the claimant has a need to enrol with Work and Income NZ, assist them with this
process.
11 Claimant notification of further rehabilitation needed
12 General practitioner notification of compensation cessation
Pain questionnaires
About the pain questionnaires
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts. '
Forms ACC2781 and ACC2812 are modified versions of the Acute Low Back Pain
Screening ouestionnetre', Evidence shows that this screening questionnaire is valid for
identifying people who are likely to develop pain-related disability and work loss.
Because it's effective in predicting claimants who are likely to remain off work, you only
need to get the claimant to complete the relevant questionnaire once during the claim
process, at the first instance when you identify that pain is an issue. That will most
commonly be while you gather information, but it can be at any stage, such as when
you make the risk assessment, or monitor the claim.
Because there's a non-earner and an earner version of the questionnaire, make sure
you use the correct version:
• Use the earner questionnaire if the claimant was in paid work at time of injury or
incapacity.
• Use the non-earner questionnaire if they weren't in paid work at that time.
Note:
Pain is more likely to be a factor in high and medium risk claims, but you could need to
get a low risk claimant to complete the questionnaire, for instance if it appears as a risk
factor when you complete the RAC in Pathway (as described in the procedure for
assessing risk).
How to use the questionnaire results
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed Linder other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
Depending on the score the. claimant receives from the questionnaire, you need to
adjust your case management approach to take account of pain as a risk factor for the
claim. The additional activities you need to carry out are described in the relevant
topics later in this document for earners and non-earners.
Remember though that the questionnaire is a screening tool, not an information
gathering tool. Don't use the specific answers to dictate your case management
decisions (although you can take reasonable account of them).
Low Back Pain
This information relates to ACC's application of the AI Act 1998 and other previous
legislation that applied under that Act. After 1 April 2002 some claims may still be
managed under other Acts. For specific information on transitioning claimants refer to
claims lodged under previous acts.
If the claimant presents with low back pain, you should also ask the claimant to
complete the following pages of the Acute Low Back Pain management: Patient Guide":
1 Pain questionnaire - earner
2 Pain questionnaire - non-earner
3 Linton & Hallden, 1996
4 Accident Compensation Corporation and the National Health Committee, Wellington,
NZ, 1998

that is the first volume There is another 12 for you to study sparrow to see what the purpose and object of the staff in ACC are doing.
0

#15 User is offline   Alan Thomas 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 10801
  • Joined: 10-June 06

Posted 26 May 2009 - 06:02 PM

Doppelganger there is very little point in copying the ACC mistakes onto this site. ACC policy has absolutely no relationship to the legislation in the manner in which you have just posted. Instead of just repeating their mistakes why not analyse their mistakes!
0

#16 User is offline   Jack 

  • Member
  • PipPip
  • Group: Members
  • Posts: 22
  • Joined: 26-February 07

Posted 26 May 2009 - 07:05 PM

View Postmarypoppins, on May 26 2009, 04:23 PM, said:

Avoid Kelly Retter at all costs.I was assessed by her some years ago. Despite a shoulder injury she stated I would be able to be a mail sorter, horticultal nursery worker & with basic office experience that I could be a Human resources manager & aduitor.When I pointed out to her that I didnt have those skills or anything close to it I was ignored.Her and her sister are on the Acc gravy train so to speak.


hi MaryPoppins,
many thanks for this helpful info.
kind regards
Jack
0

#17 User is offline   doppelganger 

  • Advanced Member
  • PipPipPip
  • Group: Members
  • Posts: 1740
  • Joined: 19-September 03

Posted 26 May 2009 - 07:55 PM

View PostAlan Thomas, on May 26 2009, 06:02 PM, said:

Doppelganger there is very little point in copying the ACC mistakes onto this site. ACC policy has absolutely no relationship to the legislation in the manner in which you have just posted. Instead of just repeating their mistakes why not analyse their mistakes!


I have and have decided to inform injured people on how to gain entitlements. there is on person particular that is telling claimants to follow the corporations policy.

She even suggest that job with out rehabilitation should reject jobs or rehabilitation into jobs.

an example a person with a head injury could not be put into a job as a fitter and turner as concentration is lacking and that could cause harm to others.

The same person could do a drafting job but would need Vocational Rehabilitation. the out come would be a part time job not a full time job.

it rehabilitation to minimise the cost on to the community as described in section 3.

I also read the case posted by DRSL. Just image if she had the written documents. Take note that she also has other injured in the hands. Did the Doctor make a mistake in the original injury and has the ACC carried out a full investigation? Was she assessed in injuries not causing incapacity?

Now she has to obtain employment as a social?Community worker and if unable to perform the occupation then apply for a reassessment, but she will need to make sure that those other injuries are covered first as if those injuries are taken into account she hasn't got Vocational Independence.

ACC has used the VI process to remove cover by following policy.

Take note in the case posted by DRSL the Corporation requested that the injured person leave her job so that the Corporation could carry out the Vocational Independence process. With out a job they did not need to maintain a employment.
0

Share this topic:


Page 1 of 1
  • You cannot start a new topic
  • You cannot reply to this topic

1 User(s) are reading this topic
0 members, 1 guests, 0 anonymous users