Application
This unit describes the skills and knowledge required to process and analyse workers compensation and sick leave claims. It also covers the establishment of rehabilitation needs and return to work programs and their monitoring, review and evaluation.
It applies to individuals who manage claims and ensure that the organisation provides appropriate support for the worker.
No licensing, legislative or certification requirements apply to this unit at the time of publication.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1 Analyse claims | 1.1 Ensure that the organisation has and maintains a current Workers' Compensation insurance policy (or equivalent) as required by the applicable legislation 1.2 Process claims in accordance with organisational policies and legal and insurance requirements 1.3 Dispute claims where insurer or organisational requirements are not met 1.4 Notify rehabilitation provider in accordance with organisational procedures 1.5 Advise claimants as to whether their claim has been accepted 1.6 Analyse claims to identify the nature of the illness/injury and prepare report/s 1.7 Identify projected period of absence and where rehabilitation assistance is required and ensure arrangements are made in the work team to deal with absence |
2 Establish rehabilitation/return to work program | 2.1 Ensure consultation occurs between rehabilitation provider and treating doctor 2.2 Ensure consultation occurs between rehabilitation provider, relevant managers and employee 2.3 Consider job redesign, reduced hours and alternative duties in the light of medical advice 2.4 Design a rehabilitation/return to work program to achieve a successful return to work 2.5 Obtain approval for return to work program by relevant managers 2.6 Establish rehabilitation program with employee 2.7 Undertake risk analysis in relation to proposed program and mitigate risk where appropriate 2.8 Commence program as close to the time of the accident/illness as possible |
3 Monitor/evaluate rehabilitation/ return to work program | 3.1 Encourage regular feedback/communication between provider, supervising manager and employee 3.2 Organise regular contact and support between provider and employee 3.3 Identify breaches of the return to work program and take remedial action promptly 3.4 Refer return to work program to workers compensation authorities where breaches occur 3.5 Modify return to work program where appropriate if it is not delivering the required outcomes 3.6 Evaluate each rehabilitation/return to work program at its conclusion and implement recommendations for system improvement where appropriate |
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 1.2, 1.3, 1.6, 1.7, 2.3, 2.4, 2.7, 3.6 | Evaluates and integrates facts and ideas to construct meaning from a range of text types |
Writing | 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 2.3, 2.4, 2.5, 2.6, 2.7, 3.3, 3.4, 3.5, 3.6 | Records results of analysis in required formats Prepares correspondence to a range of individual in required format Uses vocabulary, grammatical structure and appropriate organisational conventions to ensure rehabilitation and return to work programs are effectively documented |
Oral Communication | 1.3, 1.4, 1.5, 1.7, 2.1, 2.2, 2.5, 2.6, 3.3, 3.4 | Uses appropriate vocabulary and non-verbal features in discussions with employees, insurance companies and rehabilitation providers when dealing with claims |
Numeracy | 2.3, 2.4, 2.7, 3.6 | Uses basic numeracy skills to determine the appropriate amount of hours for a return to work program Selects and uses appropriate mathematical problem-solving strategies to undertake risk analysis and to evaluate the rehabilitation program |
Navigate the world of work | 1.1-1.4 | Ensures knowledge of legislative requirements and products is kept up to date in order to provide accurate information Takes full responsibility for following policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulation Seeks to improve policies and procedures to better meet organisational goals |
Interact with others | 1.5, 1.7, 2.1, 2.2, 2.5, 2.6, 3.1, 3.2, 3.4, 3.6 | Uses appropriate protocols and practices to communicate with a range of stakeholders Implements strategies to discuss health matters sensitively with a range of people Encourages collaboration between relevant stakeholders |
Get the work done | 1.1-1.4, 1.6, 1.7, 2.1-2.4, 2.6-2.8, 3.3-3.6 | Plans and organises complex tasks to ensure that that claims are properly processed and to keep the claimant informed Monitors progress of plans and schedules and reviews and changes them to meet new demands and priorities Makes critical decisions in complex situations, taking a range of variables into consideration Evaluates and analyses results of decisions to identify opportunities for improvement |
Sectors
Workforce Development – Human Resource Management