Workers who are eligible are managed under the Community Integration Program and are managed jointly by the TAC Transport Accident Commission and the Agent.
The program capitalises on the TAC’s expertise in delivering lifetime support services with a focus on improved community integration, whilst maintaining the strengths of Agent administration of weekly payments and premium collection.
The Agent identifies eligible workers and assesses eligibility for the Community Integration Program, providing a recommendation to WorkSafe.
The Agent retains responsibility for the management and administration of weekly compensation payments, common law and impairment benefits.
WorkSafe confirms eligibility for the program and authorise the involvement of the TAC to manage the long term care service needs of eligible workers.
The TAC manages the Community Integration Program through their Independence Branch, using skilled 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.
Follow these steps to review, approve and transfer a Community Integration Program claim.
|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 at the time of initial assessment. Identify workers with the following:
This should be indicated on the initial assessment form.
Upon identification of a worker who may be eligible for the CIP, review the claim with a suitably qualified person (injury management) and contact the WorkSafe CIP Program Lead to discuss further.
The CIP Program Lead will determine if additional information is required or if the Agent can proceed with completing the ‘Community Integration Program Claim Review Summary Form’. If requested, the forms must be completed within five days of the request.
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 begin procedures for 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 2 days of being advised by WorkSafe 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.
|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.
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.
The Agent and the TAC will each nominate one central point of contact for the Community Integration Program (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 employer 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 Case Manager and the TAC Support Coordinator.
Timely communication of accurate and reliable information between the Agent and the TAC is essential. In general, information relevant to the management of individual claims is 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.
The management of a claim for a worker participating in CIP is as follows:
The Agent will continue to manage most aspects of the claim, including:
- receiving Certificates of Capacity and paying weekly payments
- common law
- impairment benefits.
The TAC will manage the medical and rehabilitation aspects of the claim:
- attendant care
- nursing services
- supported accommodation
- case management
- allied health services, eg 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.
Healthcare and other service provider accounts for medical and like services are forwarded to the TAC Support Coordinator.