Compensable Systems Flashcards
(22 cards)
How long do insurers have to determine liability?
For Workers Compensations
21 days
How long can it take for AHTR to be approved?
21 days
What is a reason for a client not returning to the same employer?
Can an AEP make this decision?
They cannot fullfill the inherent requirements of the job role
No only a specialist can decide on this
What is the most common injury in CTP cases?
Whiplash
What is CTP insurance?
- Is Compulsory third party insurance (Green slip)
- is mandatory for all vehicles in NSW
- It provides insurance coverage for people injured in MVA
What is the best treatment for whiplash?
ROM and Scap work
How long can it take for a CTP claim to be approved?
4 weeks
How long do you have to lodge a CTP claim from the DOI?
28 days
What is a threshold injury?
These are considered to be “minor” injuries.
- Soft tissue or mild psychological injuries
- Entitlements can be up to 52 weeks
Examples include:
- Whiplash
- Sprains
- Bruising
- Adjustment Disorder
What is a Non-Threshold Injury?
Serious or Severe injuries requiring longer support
- Permanent psychological or physical injuries
- Entitlements longer term (weekly payments)
Examples include:
- Fractures (even a pinky fracture)
- PTSD
- Nerve Damage
- Major Depression
Why does does threshold vs non-threshold injuries matter to us as EPs?
- Impacts treatment timeframes/funding
- Helps set realistic goals
- Supports better communication with insurers
How often do you have to update the COC?
Every 28 days
What is the role of a case manager?
To get the client back to work in the most cost effective and time efficient manner
What is a recover at work plan? Why is it important?
It is a structure plan that outlines how an injured worker can safely RTW - gradually increase appropriate duties
Why it matters?
- Supports recovery with meaningful activity
- Sets clear goals and expectations
- Helps manage risk and prevents re-injury
- Required under NSW workers comp for ongoing support
REMEMBER - work is good for health and wellbeing
What is HORSE model to influence patients perception of RTW?
H = Hurdles
O = Optimism
R = Rewards
S = Schedule
E = Expectations
What are Red Flags?
Flags model
Biological factors
- Need following up
- Serious Pathology
- Failure of treatment
What are Orange Flags?
Flags model
Mental Health Factors
- Personality Disorders
- Mental health disorders
*Have to be diagnosed conditions not just they are “not feeling well/off”
What are Yellow Flags?
Flags model
Psychological Factors
- Unhelpful beliefs about the injury
- Poor coping strategies
What are Blue Flags?
Flags model
Social Factors
- Low social support
- Unpleasant work / low job satisfaction
- Non-english speaking
- Sense of injustive
What are Black Flags?
Flags model
Other Factors
- Threats to financial security
- Litigation
- Compensation thresholds
What is the Code EPA002?
What is the cost?
What are the benefits?
Is the code for a standard consultation
- Fee is $96.50 (usually 30 min duration)
Usually utilised in less complex cases
Has less financial burden
What is the Code EPA009?
What is the cost?
Benefits/Use?
Consultation C - $18.70 / 5 minutes
- More expensive form of treatment
- Can be used to increase session duration to better optimise clients performance outcomes
- Used in more complex cases
- Need 3 or more separate compensable injuries/conditions
