5.5.3 Agent prior approval of OR services
Except where OR Occupational Rehabilitation services have been provided to the worker by the employer under the employer excess, the Agent must approve an OR Service and the specific type of OR Service, before it is provided to a worker.
Worker choice of OR provider
Workers are entitled to receive an OR service from an approved OR provider of their choice.
See: Worker choice of OR provider
OR service commencement is initiated via an OR Approval Form
An Agent will complete and send an OR approval form to the worker's choice of OR provider attaching relevant medical opinion/information regarding the worker's capacity for work and any work restrictions.
After receiving an OR Approval form, the OR provider must telephone the Agent, the worker and injury employer.
The OR provider will confirm the Agent’s understanding of the circumstances that lead to the claim and confirm why the OR service was approved. The OR provider will also seek clarification about any matter that may be unclear.
In the worker and injury employer discussions, the OR provider will confirm their understanding of the circumstances that led to the claim and establish what issues or barriers the worker or the injury employer may consider are delaying or impeding a return to work. The OR provider will also check their availability for a face to face meeting as soon as it is practicable. This information will also be used by the OR provider to form a preliminary view before the meetings as to what activities may be needed or issues that may need to resolved to facilitate a negotiated return to work for the worker.
See: Safety & security - third party providers
Funding approval subsequent to an OR Approval Form
Funding extensions to previously approved service types are requested by the OR provider via an Initial or Additional Funding Request. The Agent has three working days to respond in writing, before an OR provider may automatically proceed with the requested servicing, to avoid interruption of servicing and/or RTW Return to Work.
Exceptions where an OR provider must obtain Agent written approval (the OR provider may not automatically proceed) include:
- commencement of new service types (not previously approved via an OR Approval Form)
- OES Original Employer Services beyond the first three months of aggregate servicing (excluding periods of service suspension) and monthly thereafter until 100% pre-injury hours commence
- OES beyond commencement of a 13 week sustainability period.
Expiry of funding approval
Any unused portion of approved funding:
- from an Initial Funding Request expires three (3) months from the date of Initial Report submission or on submission of an Additional Funding Request
- from an Additional Funding Request, expires one (1) month from the approval date and/or on submission of every subsequent funding request
- for a 13 week sustainability period, expires at the end of the 13th week
Update ACCtion payment profile after OR services are approved
WorkSafe recommends that the ACCtion payment profile is updated each time OR services are approved to ensure only OR services which have been approved by the Agent are paid.
Suspension and cessation of servicing
Agents can request that an OR service is suspended or ceased.
Services should be suspended as soon as a worker is expected to be unfit for a period of 4 weeks or more. Services should cease as soon as a worker is expected to be unfit for a period of 3 months or more.
Additional guidance is provided in the WorkSafe Victoria Occupational Rehabilitation Fee Schedule.