- Dr David Colvin
Who are all these people?
claim management
Employer and the Insurer
The two initial participants are the employer and the insurer. Once you have reported an injury to the employer, they will initiate a claim with their insurer and you will receive a claim number. In a small company, you may be dealing with the employer directly, but in larger companies this may be done via an internal injury management staff member.
Claim Manager
At this point, the insurer will appoint a claim manager and you will receive notification that your claim has been accepted and that notification will include the name of the claim manager. This is a very important person in the overall progression of your claim and hopefully you will have a clear line of communication with that person. They will be responsible for approving all treatment costs associated with your claim.
Medical Team
There will be a medical “team” associated with treating your injury. You may have consulted your own general practitioner about the injury or alternatively the employer may have an injury management plan which includes an occupational physician affiliated with the company who is an expert in managing work injuries.
An important point to make at this stage is that it is an enshrined feature of the workers’ compensation scheme that the patient has a choice in terms of service providers. This applies to almost everybody associated with your claim other than the insurer. It certainly applies to the medical team, and you can change your treating doctors and specialists if you wish. Some patients feel uncomfortable seeing the “work” doctor and prefer to deal with their own general practitioner. However, the work doctor will usually be a qualified occupational physician and will almost certainly have a much better understanding of the workers’ compensation system, which can be very beneficial in the management of your claim.
The other point to understand is that the insurer can insist that you attend medical reviews with other independent doctors. These reviews are for the provision of medical reports and not to institute treatment (Independent Medical Examination IME). The report may advise on whether the proposed treatment is appropriate for the insurer to fund.
Specialist
The treating doctor may refer you to a specialist and that is where I come in. Again you have the choice of specialist if you wish to exercise that choice. Specialists are independent, and not affiliated with the insurer.
Allied Health Professionals
Other allied health professionals may be involved in your medical treatment including physiotherapists, exercise physiologists, and for some, clinical psychologists.
Vocational Rehabilitation Provider
If it is anticipated that you may have a very protracted return to work or that you may not get back to your pre-injury occupation, a vocational rehabilitation provider might be engaged. Think of this person as a liaison between you and the employer to manage your return to work. They can ensure that you are not asked to do duties beyond your capacity or unsafe for your injury during that return to work period. They also help identify alternative occupations if you are not returning to your previous role.
In a large company, this vocational rehabilitation process may be managed internally.
Conclusion
So there you have it, a bewildering array of people involved in your claim, which can create a daunting number of appointments. Know who they are and know what they are doing for you. Do not be afraid to contact them directly and keep the channels of communication open.