2.6.4 Community Integration Program (CIP)
2.6.4.1 Review, approval & transfer of claims | 2.6.4.2 Eligibility criteria for Community Integration Program (CIP) | 2.6.4.3 Organisational structure CIP | 2.6.4.4 Manage a Community Integration Program (CIP) claim
Workers suffering from a severe or moderately severe acquired brain injury (ABI) or spinal (paraplegia or quadriplegia) injury may be eligible to be managed under the CIP. If a worker is approved for the program their claim is managed jointly by the TAC Transport Accident Commission and the Agent.
The program capitalises on the TAC’s experience in delivering lifetime medical and like support services with a focus on improved community integration, whilst maintaining the strengths of Agent administration of weekly payments and premium collection.
Agent's role
The Agent identifies eligible workers for the CIP, providing a recommendation to WorkSafe.
The Agent retains responsibility for the management and administration of weekly compensation payments, common law, impairment benefits and Return to Work.
WorkSafe's role
WorkSafe confirms eligibility for the program and authorises the involvement of the TAC to manage the medical and like entitlements of eligible workers.
TAC's role
The TAC manages the CIP through their Independence Branch, using support coordinators and relevant clinical resources. The TAC is responsible for the administration authorisation and payment of reasonable medical and like services in line with the legislation and WorkSafe policies.
2.6.4.1 Review, approval & transfer of claims
Follow these steps to review, approve and transfer a CIP claim.
| Step | Agent action |
|---|---|
| Potential CIP claim identified |
A CIP claim may be identified by WorkSafe or by the Agent. WorkSafe expects Agents to identify workers who may be eligible for the CIP as soon as possible after the worker's injuries are known. Eligible workers will have the following injury/s:
The abovementioned injury/s should be indicated on the initial CIP form. Upon identification of a worker who may be eligible for the CIP, a review of the claim should be undertaken with a suitably qualified person (i.e. Injury Management Advisor) and the appropriate ‘Community Integration Program Claim Review Summary Form’ completed and sent through to WorkSafe's nominated representatives. If requested, the forms must be completed within five days of the request. See: Community Integration Program Review Summary Form: Acquired Brain Injury | Community Integration Program Review Summary Form: Spinal Discuss the worker’s medical status and prognosis with the treating team, hospital and family. However, at this stage, the Agent should only discuss the potential transfer of the claim to the CIP with WorkSafe. |
| WorkSafe reviews eligibility |
WorkSafe must authorise the eligibility of a worker for the CIP (and transfer to the TAC). WorkSafe will review the Agent’s recommendation and documentation. WorkSafe may request additional information before making a decision. If authorised, WorkSafe will notify the Agent and the TAC to facilitate the transfer. If WorkSafe determines the worker does not meet the CIP criteria, the Agent continues to manage all aspects of the claim. |
| Agent transfers claim |
WorkSafe will liaise with TAC and the Agent to determine a transfer date. Within two days of being advised by WorkSafe, the Agent must contact the worker and to advise them of the proposed transfer date. Before the transfer date:
The Agent will continue the management and administration of weekly compensation payments, Common Law and Impairment Benefits and Return to Work. |
| TAC starts claims management |
From the agreed transfer date, the TAC will manage all medical and like aspects of the claim. The TAC reviews the claim information and updates their claims management system. Within seven days of WorkSafe confirming the transfer of the claim, the TAC should arrange an initial meeting. This meeting should take place within 14 days of the TAC commencing management of the claim. |
2.6.4.2 Eligibility criteria for Community Integration Program (CIP)
Workers with the following injuries may be eligible for CIP referral.
Spinal injury resulting in quadriplegia or paraplegia
Quadriplegia (or Tetraplegia) refers to a spinal cord injury above the first thoracic vertebra affecting the cervical spinal nerves resulting in paralysis of all four limbs. In addition to the arms and legs being paralysed, the abdominal and chest muscles will also be affected resulting in weakened breathing and the inability to properly cough and clear the chest.
Paraplegia refers to a spinal cord injury below the first thoracic spinal nerve. The degree of motor or sensory loss can vary from the impairment of leg movement to complete paralysis of the legs and abdomen up to the nipple line. Individuals with paraplegia have full use of their arms and hands.
An ABI rated as severe or moderately severe
An acquired brain injury (ABI) is an injury sustained to the brain which is not hereditary, congenital, degenerative or induced by birth trauma. It is defined as an injury to the brain that occurs after birth and may be caused by trauma, illness or disease.
Agents are required to ascertain the severity of the ABI, using objectives outlined in the WorkSafe eligibility criteria that are relevant for assessment of severity.
2.6.4.3 Organisational structure CIP
The Agent and the TAC will each nominate one central point of contact for the CIP.
The Agent will liaise with the designated TAC Team Manager for contact about:
- organisational, administration and resourcing matters
- overall cohort management – including claims transfer notification and management and claim review requirements
- liaison with WorkSafe.
Coordination of individual claims
Day to day claims management, administration and case management for individual claims is coordinated between the allocated Agent Case Manager and the TAC Support Coordinator.
Communication
Timely communication of accurate and reliable information between the Agent and the TAC is essential. Information and decisions relevant to the management of individual claims should be made available as it comes to hand.
Share critical information or incidents immediately by telephone.
New information received should be forwarded to the TAC with a brief summary of the information entered in ACCtion.
New information received or decisions made should be noted in ACCtion and a copy forwarded to the Agent to be kept on their file.
2.6.4.4 Manage a Community Integration Program (CIP) claim
The management of a claim for a worker participating in CIP is as follows:
Agent
The Agent will continue to manage most aspects of the claim, including:
- receiving Certificates of Capacity and paying weekly payments
- common law
- impairment benefits
- Return to work.
TAC
The TAC will manage the medical and like aspects of the claim including:
- attendant care
- nursing services
- supported accommodation
- case management
- allied health services (e.g. physiotherapy, occupational therapy Occupational therapy is a client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to or are expected to do or by modifying the occupation or the environment to better support their occupational engagement. and speech therapy)
- payment of all invoices for medical and like services.