Injury Management Programs and Plans

One of the main tools that insurer’s utilise to determine how they will manage your claim is an Injury Management Program.

When an insurer is notified of an injury, they start following steps outlined in their Injury Management Program. One of the first steps they should take is develop an Injury Management Plan. If you are unfamiliar with the workers compensation system, you may not know what that is, or what your rights and obligations are. At Turner Freeman Lawyers, our experienced workers compensation lawyers are here to help.

Injury Management Programs

Under section 43 of the Workplace Injury Management and Workers Compensation Act 1998 (‘the WIM Act’), a workers compensation insurer is obligated to establish and maintain an Injury Management Program. An Injury Management Program is a:

co-ordinated and managed program that integrates all aspects of injury management (including treatment, rehabilitation, retraining, claims management and employment management practices) for the purpose of achieving optimum results in terms of a timely, safe and durable return to work for injured workers.[1]

It is a program/model that insurers use to determine how to manage all aspects of a claim from start to finish.

The goal of an Injury Management Program should be to obtain the best outcome for workers by helping them return to work safely, quickly, and in a sustainable way. It usually includes information about:

• the legislation that is used to develop the program;
• procedures relevant to helping a worker return to work;
• claims management procedures, such as how an insurer calculates weekly payments;
• how decisions are made relating the medical treatment;
• how to manage employer practices;
• the obligations, rights and responsibilities of relevant parties such as the worker, the worker’s GP, the employer, and the insurer.

The insurer must start the steps outlined in the Injury Management Program within 3 working days of being notified of a significant injury, and contact the worker in accordance with that program.[2] A significant injury is an injury that is likely to result in the worker being unable to work as they normally would for more than 7 days.

Injury Management Plans

As part of the Injury Management Program, one of the first things the insurer should do is begin to establish an Injury Management Plan.  This is an individualised plan regarding the management of your injury and return to work that is tailored specifically to you and your injury.[3]  An Injury Management Plan is defined in the WIM Act as:

a plan for co-ordinating and managing those aspects of injury management that concern the treatment, rehabilitation and retraining of an injured worker, for the purpose of achieving a timely, safe and durable return to work for the worker. An injury management plan can provide for the treatment, rehabilitation and retraining to be given or provided to the injured worker.[4]

It is a written plan that sets out your goal for recovery (e.g. to be able to return to work) and the actions each party involved should take to help you achieve that goal. The plan should be established in consultation with your employer, your GP and yourself. It should be developed as soon as possible, but no later than 20 working days from the date it becomes apparent that you have a significant injury. This could be the date the insurer was notified of your injury, or after you have been unable to return to work for more than 7 days.

What are my rights and obligations?

Your employer must participate and co-operate in the establishment of an Injury Management Plan and comply with any obligations imposed on it under the plan. However, there are also obligations imposed on you by the workers compensation legislation.

You are required to participate and co-operate in the establishment of the plan and comply with any obligations imposed on you under the plan. Additionally, you are required to nominate a treating doctor who is prepared to participate in the establishment of the plan and act in accordance with it.

If you wish to change your nominated treating doctor, the plan should provide for a means for you to do so.

For more information about Injury Management Programs and Plans, contact one of our experienced workers compensation lawyers on 13 43 63.

[1] Workplace Injury Management and Workers Compensation Act 1998 (NSW), s 42.

[4] Ibid s 42.