NT Worksafe and the Role of
General Practitioners
Northern Territory Workers Compensation Scheme
What we do
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Occupational Health and Safety
Dangerous Goods
Electrical Safety
Mines and Major Hazard Facilities Safety
Workers Compensation & Information
Workers’ Compensation Scheme
Operates under the
• Workers Rehabilitation and Compensation Act
• Workers Rehabilitation and Compensation Regulations
About the Scheme
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No fault scheme
No common law access
Privately underwritten
Multiple insurer scheme
– 5 approved insurers
– 4 self insurers
– Nominal Insurer
• Premiums are not regulated and are set by individual insurers
Who is eligible?
for Workers compensation
under the Northern Territory
Workers Rehabilitation and
Compensation Act
Who is excluded?
• Workers who have submitted their ABN in writing to their
employer
• Commonwealth employees (covered under Comcare)
• Family member, except where specifically named
• Company Director, except where specifically named
• Any person or class of person excluded by Regulation
• Volunteers (unless those prescribed) and most
sports persons
When to make a claim
• A claim can only be made if the injury or disease arises out of
or in the course of the worker’s employment
• Gradual onset injuries or diseases must be materially
contributed to by the worker’s employment, this is defined as
the employment being the real, proximate, or effective cause
• Journey claims, however most journey claims involving motor
vehicles to and from work are not workers’ compensation and
are covered by Motor Accidents Compensation Scheme
Claims process
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A worker must inform their employer as soon as practicable
after becoming aware of an injury or disease
• The worker completes the first two pages of the workers’
compensation claim form
The worker must:
1. Sign and date the declaration
2. Sign authorisation to release medical information
- if not signed the claim will not be recognised as a claim for
compensation
Claims process
• If the claim is for lost time an approved workers’
compensation medical certificate must accompany the claim
form
• If the claim is for medical expenses only, the approved
medical certificate is not required
• The worker hands or sends the completed claim form to their
employer
• On past statistics about 95% of claims will be accepted with
approximately 5% being deferred or rejected
Doctors role
• Except in certain remote situations* General Practitioners are
the sole authority to issue medical certificates for lost time by
injured or ill workers
• The medical certificate provides information to assist the
insurer in deciding whether to accept the claim and how to
best manage the claim
• Participation in case conferences, treatment
and management of injury and return to
work programs
* Registered nurses and aboriginal health workers can issue limited medical
certificates in remote locations.
Medical certificates
There are three types of NT Workers’ Compensation medical certificates:•
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First Certificate: completed at the first consultation and covers first 14 day period. If
the claim is for lost time, this medical certificate must be attached to the claim form.
This is the only workers’ compensation medical certificate that is mandatory for lost
time claims.
Progress Certificate: for continuing periods of partial or total incapacity and covers a
maximum period of 28 days – This form was designed to provide the insurer with
relevant and adequate medical information for the management of workers’
compensation claims.
Final Certificate: to be issued when the worker has fully recovered or ceases to be
incapacitated from work related condition.
NT WorkSafe does not regulate fees and charges. However, the scheme provides for the
payment of a worker’s reasonable medical, surgical and rehabilitation expenses.
Medical certificate issues
Past reviews of medical certificates indicated problems around the
following issues:
• Almost 50% of First Medical Certificates submitted provided a
generic rather than specific diagnosis;
• Less than 30% of the First Medical Certificates contained a
completed medical practitioner/employer contact section; and
• More than 30% of Progress Medical Certificates were not completed
fully, particularly with regard to the clinical findings, diagnosis and
injury management sections.
Unfortunately where these shortcomings occur the effectiveness of the
medical certificate is compromised
First Workers Compensation Medical
Certificate
Medical certificates
• Worker and employer details section
• Injury details section
– Date injury first noticed
– Worker’s description of injury
– Further investigation is permissible e.g. speaking with employer
– Worker’s description of how injury occurred
• Medical Assessment
– Examination
– Investigations
– Diagnosis – particularly in progress certificates
Medical certificates
• Fitness for work
– Consultation with the employer is permissible when completing
this section
– Detail what restricted duties are involved and include what the
worker can do
– Communication with employer, insurer and rehabilitation provider
about restrictions
– Case conferences include all parties to the claim process,
including the insurer (case manager), rehabilitation coordinator,
the worker and the employer and can be charged at a
reasonable rate
Medical certificates
Injury management
• Communication is the key
All aspects of the medical management plan should be completed
including medication
Referrals in cases where diagnosis may be unclear or uncertain
It is imperative that as much information as possible is provided to
allow for decisions to be made promptly because:
Without sufficient information, independent examiners are often
sought to provide advice
Patients may experience some delays while more information is
being obtained
Rehabilitation
Injury Management
• The principles of injury management and return to work are the
primary objectives of the workers’ compensation scheme
• Rehabilitation is the process of restoring, as far as is practicable, a
worker to the same physical, economic and social condition to which
the worker was before the
work related injury
• A goal of rehabilitation is to return the worker to the workplace as
soon as it is practical
• The insurer must approve the referral before rehabilitation
can proceed
Rehabilitation
Worker responsibilities
• To undertake all reasonable treatment and training or
assessment and return to work programs, as part of the
rehabilitation process
• This may involve doing different duties until they are fit for
their former work
• If the worker is unable to return to their former job, they may
need to be retrained for other work
• Failure to co-operate can lead to a reduction or cancellation of
benefits
Rehabilitation
Employer responsibilities
• An employer is required to assist the worker with the rehabilitation
program and take all reasonable steps to provide or obtain suitable
employment for the worker
• So far as is practicable, participate in efforts to retrain the
injured worker
• Ensuring, if necessary, that there is a referral to an accredited
vocational rehabilitation provider who can help to devise and
implement a suitable early return to work plan
• If the employer is unable to provide the worker with suitable
employment, the employer in consultation with the insurer must refer
the worker to an Alternative employer incentive scheme
Dispute resolution
• Mediation
• Work Health Court
• Permanent Impairment Reassessment
Mediation
If a claimant disagrees with an insurer’s decision they may
initiate the mediation process through NT WorkSafe either
by:
1. Completing the request for mediation slip accompanying the
notice of decision
2. Write to NT WorkSafe clearly stating the nature of
the dispute
Work Health Court
If a party to a dispute is dissatisfied with the outcome of the
mediation process they may then make an application to the
Work Health Court.
An application to the Work Health Court should be made within
28 days of the party receiving Certificate of Mediation,
although the Court has the power to extend the 28 day time
limit.
The Work Health Court is constituted by a magistrate or,
in certain circumstances, the Registrar or Judicial Registrar.
Permanent Impairment Reassessment
If a worker believes that they have a permanent impairment, they
may apply to their employer’s insurance company, or their
own doctor, for an assessment of that impairment.
If the worker or the insurer is dissatisfied with the original level of
permanent impairment percentage, either may apply to
NT WorkSafe for a reassessment. Such applications must
be in writing.
NT WorkSafe must receive an application for a reassessment
within 28 days of the insurer or worker being notified of the
result of the initial assessment.
Further Information
www.worksafe.nt.gov.au
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Doctor's Information Kit
A Doctor's Role in Injury Management
The Evaluation of Permanent Impairment
Permanent Impairment Assessment/Reassessment Checklist
Doctors' and Allied Professionals' Frequently Asked Questions
Doctor's guide to permanent impairment reassessment
medical reports
Contact Us
For further information or assistance in claims management
contact the workers’ compensation insurer or NT WorkSafe
Workers’ Compensation Advisory Line:
08 8999 5585 / 1800 250 713
This information is for training purposes only. No part may be reproduced without the
permission of NT WorkSafe. The information contained in this presentation is
accurate at the date of production 29 June 2010.