Afiq Abdul-Malek

WorkCover - making it easy

Transcript

1. WorkCover – making it easy Presented by: Afiq Abdul-Malek
2. Agenda 2 WorkSafe & Agents Common Issues Clinical Framework Consultations
3. What is WorkCover? •  Statute based scheme •  Provides benefits to injured workers •  Protects employers against economic and non- economic loss suffered by injured workers •  Administered through Agents, such as GB 3
4. Who runs the scheme? •  The scheme is run by WorkSafe Victoria •  They regulate, oversee, and underwrite the scheme 4
5. About WorkSafe •  Help avoid workplace injuries occurring •  Enforce Vic’s OH&S laws •  Provide workplace injury insurance for employers •  Help injured workers back to work •  Manage the workers' compensation scheme 5
6. Outsourcing to Agents •  Agents are appointed by WorkSafe to manage WorkSafe insurance •  These organisations perform most of the functions associated with premium and claims management. •  They also provide advice to help injured workers return to work. 6
7. Who are the Agents? Who? Gallagher Bassett Allianz EML Xchanging CGU 7
8. GB’s role as a WorkCover Agent •  Determine premiums for individual employers based on a set formula •  Collect premiums •  Manage claims in accordance with the WorkCover legislation, the Agency Agreement, and policies, procedures, and standards set by WorkSafe •  Provide claims and risk management services to employers 8
9. The legislation •  WC claims are managed in accordance with: –  The Accident Compensation Act 1985 –  The Workplace Injury Rehabilitation and Compensation Act 2013 –  Occupational Health and Safety Act 2004 9
10. So where do Osteos fit in? 10
11. Consultations WorkSafe will only pay for osteopathy services by providers who are: •  registered by WorkSafe to provide osteopathic services •  registered with the Osteopathy Board of Australia 11
12. Consultations 12
13. WorkSafe will pay for: •  Treatment for a work-related injury or illness •  The provider is currently registered as an osteopath with WorkSafe •  The service is in line with the principles of the Clinical Framework 13
14. WorkSafe will NOT pay for: •  Non-attendance/cancellation •  Telephone consults •  Concurrent treatment •  More than one consult on the same day •  Consumable items •  Items invoiced as ‘miscellaneous’ 14
15. OS100 Forms 15
16. Clinical Framework Measure and demonstrate the effectiveness of treatment Adopt a biopsychosocial approach Empower the IW to manage their injury Implement goals focused on optimising function, participation, and RTW Base treatment on the best available research evidence 16
17. Common issues •  Gap in treatment •  Concurrent treatment •  Multiple services in one session •  S232 / S99AD •  Clinical Panel 17
18. For more information… •  http://www.worksafe.vic.gov.au/ •  http://agentonline.services.workcover.vic.gov.au/ claimsmanual/default.htm •  http://www.worksafe.vic.gov.au/__data/assets/ pdf_file/0017/132380/Information-on-Osteopathy- v0.01.pdf 18
19. For more information… •  http://www.worksafe.vic.gov.au/__data/assets/ pdf_file/0016/21715/osteo_TN_web.pdf •  http://www.worksafe.vic.gov.au/__data/assets/ pdf_file/0005/194342/WS-Osteopathy-Fee- Sch.-20160701.pdf 19
20. 20 Questions?