4.5.33.1 Network pain management program
The following work practices are to be read in conjunction with the Pain Management and Network Pain Management Programs.
Please note: These work practices are related to Network Pain Management Programs only and do not apply to any other Pain Management Program.
| Step | Agent action |
|---|---|
| Review request |
Following a referral from a medical practitioner, physiotherapist, psychologist or OR provider, the Network PM Program provider submits a Network PM: assessment request form to the Agent. Reviews the Network PM: Assessment Request form and the worker’s claim file to determine whether liability for a Network PM assessment and program should be accepted. See: Review request |
| Determine suitability of the worker |
The Network PM provider arranges a time with the worker to conduct an assessment within 20 working days of receiving approval from the Agent. |
| Monitor and document process |
Monitor and documents the progression of the worker participating in the Network PM program. |
4.5.33.2 Review request
Following a referral from a medical practitioner, physiotherapist Registered physiotherapist means a person registered under the Health Practitioner Regulation National Law to practise in the physiotherapy profession (other than as a student)., psychologist Registered psychologist means a person registered under the Health Practitioner Regulation National Law to practise in the psychology profession (other than as a student). or OR Occupational Rehabilitation provider, the Network PM Program provider submits a Network PM: assessment request form to the Agent.
The Case Manager receives the form and places a copy of the form on the worker’s file.
Review assessment request form
Review the Network PM: Assessment Request form and the worker’s claim file to determine whether liability for a Network PM assessment and program should be accepted.
A suitably qualified person (injury management) and case manager discussion
Information to be reviewed and discussed by a suitably qualified person (injury management) with the Case Manager should include:
- previous and current medical and allied health treatment
- previous pain management programs and
- Medical Advisor reviews.
Following the discussion, the suitably qualified person (injury management) and Case Manager should determine if further information is required. If this is required, a written request for further information or a telephone call to the referring medical practitioner, Network PM provider or worker should occur within 10 working days of receipt of the form. Request a THP Treating Health Practitioner report or refer the worker for an IME Independent Medical Examiner / Independent Medical Examination with the appropriate specialist if necessary.
See: Chronic pain IME
Information received should be reviewed and documented within five days of receiving the further information.
Liability issues
Review worker information to determine liability for a Network PM program assessment. This review should confirm that there is a relationship between the Network PM program and the work related injury or illness. The review may include but is not limited to:
- previous pain management programs
- recent THP reports
- recent IME reports
- recent OR reports
- Medical Advisor reviews.
In some circumstances an IME may need to be arranged to assess the worker’s pain disorder and suitability for a pain program.
As pain conditions are multifaceted in nature, they require a specific expertise to assess the condition.
See: Chronic Pain IME | Clinical Guidelines Persistent Pain Reference Guide
Where there are no liability issues, approve the Network PM assessment within five working days.
Further information or assistance required
Where there are liability issues, the suitably qualified person (injury management) and Case Manager should discuss what further information is required and acknowledge the request within five working days.
Acknowledgment of assessment request form
The Case Manager is required to tick the acknowledgment box on the Network PM: Assessment Request form, then fax or send the form to the Network PM provider within five working days of receipt of the form.
Determine liability
Where no further information is required the Agent needs to make a decision to accept or reject liability.