Application
This unit describes the skills and knowledge required to coordinate Workers’ Compensation and sick leave claims. It also covers the coordination of rehabilitation needs and return to work programs and their monitoring, review and evaluation.
The unit applies to individuals who coordinate 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
1. Coordinate claims | 1.1 Ensure that the organisation has and maintains a current Workers’ Compensation insurance policy according to required legislation 1.2 Process claims according to organisational policies, procedures and legal and insurance requirements 1.3 Notify rehabilitation provider according to organisational policies and procedures 1.4 Advise claimants as to whether their claim has been accepted, where required 1.5 Analyse claims to identify the nature of the illness and prepare required reports 1.6 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. Coordinate rehabilitation or return to work process | 2.1 Ensure consultation occurs between rehabilitation provider and treating doctor, relevant managers and employee 2.2 Coordinate job redesign, reduced hours and alternative according to medical advice 2.3 Design a return to work program 2.4 Obtain approval for return to work program by relevant managers 2.5 Coordinate return to work program with employee 2.6 Coordinate risk analysis in relation to proposed program and mitigate risk where appropriate 2.7 Commence program as close to the time of the accident or illness, as possible |
3. Monitor rehabilitation return to work program | 3.1 Encourage regular communication between provider, supervising manager and employee 3.2 Coordinate regular contact and support between provider and employee 3.3 Identify breaches of the return to work program and suggest remedial action 3.4 Refer return to work program to workers compensation authorities where breaches occur 3.5 Modify return to work program, where required 3.6 Evaluate each rehabilitation or return to work program at its conclusion and suggest recommendations for system improvement |
Evidence of Performance
The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:
on at least two occasions process a workers compensation claim
on at least two occasions coordinate the rehabilitation or return to work process for an individual.
In the course of the above, the candidate must:
process sick leave claims
coordinate rehabilitation needs and return to work program including
identifying breaches
liaising between the claimant, workers compensation authority, rehabilitation provider, doctor and workplace
determining the extent to which the program meets its objective in respect to timeframes, success rates, cost and impact on the organisation
assist in conducting a risk analysis of a return to work program and mitigate identified risks including
apply relevant legislation to return to work programs.
Evidence of Knowledge
The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:
key aspects of rehabilitation concepts and return to work procedures
relevant legislation from all levels of government that affects rehabilitation and return to work programs
role of Workers’ Compensation authorities and tribunal procedures
methods to process claims.
Assessment Conditions
Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.
This includes access to:
workplace documentation and resources relevant to performance evidence
relevant workplace policies and procedures
relevant legislation, regulations and codes of practice.
Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.
Foundation Skills
Reading | Evaluates and integrates facts and ideas to construct meaning from a range of text types |
Writing | 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 | Uses appropriate vocabulary and non-verbal features in discussions with employees, insurance companies and rehabilitation providers when dealing with claims |
Numeracy | 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 |
Initiative and enterprise | Ensures knowledge of legislative requirements and products is kept up to date in order to provide accurate information Takes 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 |
Problem solving | Implements strategies to discuss health matters sensitively with a range of people Makes critical decisions in complex situations, taking a range of variables into consideration |
Planning and organising | 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 |
Sectors
Technical Skills – Human Resources