Are workers’ compensation authorities supporting great rehabilitation and return to work outcomes? In this state-by-state series, we ask representatives of the occupational rehab industry what they think.

Today we chat to Rob Gordon, immediate past-president and now vice-president of the West Australian branch of the Australian Rehabilitation Providers Association - the industry body representing providers of Workplace Rehabilitation across Australia. Rob is also CEO of WorkFocus Australia.

What’s working in your state?

“Having experience in a number of the other schemes around the country,” says Rob, “I’d say WA is the best operating-structure. From a relationship point-of-view, the WorkCover authority does an excellent job."

Rob outlines some of the reasons for this.

WorkCover WA’s financial-structure supports RTW

“Unlike New South Wales and Victoria that are state-based WorkCover schemes, WA is privately underwritten,” explains Rob. “I personally think there are a lot of advantages with that. Not only does it give a degree more flexibility, it also allows the insurers to reward good performance.

“There’s more flexibility with regard to premium-setting than there would be in a state-run scheme, where you’re basically paying for your workers’ comp based on a service price, and the price would be fixed regardless of which claims agent you’re going through. So, you’re changing or staying with an agent in one of the other states based on service, not on price.

“So, in a sense, [this] rewards – or penalises – either strong or poor performance when it comes to rehabilitation and return to work. That’s a real motivator for employers to engage and support the rehabilitation process and get their injured workers back to work.”

Appropriate incentive for providers

“There’s a statutory entitlement under the act for wages for medical and for vocational rehabilitation which is indexed each year,” says Rob. “So, it [the entitlement] keeps pace with what’s needed in order to assist rehabilitation as part of the process.

This allows rehab providers to get on with running their business and focus on achieving RTW outcomes, explains Rob.

“[In WA] there’s a high degree of certainty around service-delivery, price models – all those sorts of things – which doesn’t always exist in some of the other jurisdictions.

“What certainty gives you is the ability to invest in your professional staff, your systems, etc, because the goal-posts aren’t moving every five minutes. You’ve got your accreditation and licensing, you’re very clear as to what the fee-structures are, and basically you’re just allowed to get on and do the job.

Stakeholder relationships

Rob evaluates the relationship between rehab providers and the WA WorkCover authority as a healthy one. “WorkCover sees rehab providers and the rehab system as a very important and integral part of the RTW process,” Rob says.

“The senior management at WorkCover WA is excellent in their stakeholder relationships. [They are] looking at how things are going, what can they do to help, how are things for the members and, [asking] ‘how can we team with them in doing things?” explains Rob.

This collaborative ethos ensures the service delivery objectives are met effectively and efficiently.

“They’re not making decisions and then putting them out there,” says Rob. “WorkCover see the providers – and particularly the provider association – as the preeminent professionals in this area. They’re very inclusive in their discussions and decision-making, and recognise that the providers are not there only from a self-interest point-of-view, we’re very happy to provide the authority with on-the-ground, objective information about things that are working and things that aren’t, and be part of that process as a stake-holder and partner.”

What’s not working?

Referral timeframe

While Rob’s outlook on the WA system is generally positive, he does think that there could be an improvement in earlier referrals.

“I’m not saying I think it needs to be mandatory referral, but it’s a strong encouragement to insurers and certainly to employers to say that early referral will benefit far more than holding and waiting.
Rob says in some cases, insurers say they’ve not received notification of an injury for up to a number of weeks. “By the time it is processed, the clock’s already been ticking on someone’s injury,” he warns,

“For me, that argument probably could wash ten years ago when it was all paper forms.” Rob suggests digitising claims - to streamline the rehabilitation process.

“If the system allowed for some sort of upload and processing immediately as the injury happens, it would avoid [insurers] waiting for paperwork to all come through. There’d be a certain amount of triggers that – providing these criteria are met – there’s an acceptance of the claim for a certain period of time to keep things moving.” This would allow rehab providers to jump in at the beginning of an injury, because, “the sooner you can get things active, the better.”

WA: wrap-up

Overall, Rob is positive about the WA scheme and doesn’t have a lot of suggestions for improvements. It’s difficult, however, to measure the scheme’s success with durable return to work rates from an outsider’s perspective - partly because WA chooses not to participate in the HWCA return to work monitor. Despite this fact, it doesn’t seem to be because WA has anything to hide.

“I think when the relationship’s healthy and when the fee-model’s healthy, you’re normally able to talk through any of the issues that are there,” he says. “And you can certainly predict issues in advance - if something’s looming and it doesn’t fit right. [WorkCover] are very open to feedback suggestions and otherwise.

“Relationships with the authority can be strained if the authority’s got a certain view on things and they want to force it through. That’s certainly not the case in WA; they’re very much in partnership with the decision-making. There’s a respect that it’s not a self-preservation exercise from the providers to just say what they would like, but say what’s in the best interests of the scheme.”

“What providers need is certainty of business continuity – because they’re investing. They need a fair and reasonable rate, they don’t need to be tied down with having to justify every single thing that’s being done with excessive paperwork and process, and they need to be treated as the preeminent professional in their area.

“If those things all stack up, they can get on and do their job.”