2.7.1 THP reports
2.7.1.1 Purpose of a THP report | 2.7.1.2 Types of THP reports | 2.7.1.3 Medical report requested by the worker | 2.7.1.4 Review & action report
Note: Any reference to an independent medical examination and examiner (IME Independent Medical Examiner / Independent Medical Examination) in this section also includes a reference to an independent impairment assessment and assessor (IIA Independent impairment assessment) for the purposes of assessing a worker’s entitlement to weekly payments after the expiry of the second entitlement period. For a detailed discussion on IIAs, please see 2.7.7
A treating health practitioner (THP) is a registered medical practitioner or a registered allied health service provider who provides services to a worker.
A THP report is completed by a THP who is authorised to report on services and clinical information about a worker’s work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. injury or illness.
Approved providers of THP reports
Agents may request a THP report from the following registered or WorkSafe approved providers of services to workers:
- Medical Practitioner
- Dentist
- Optometrist
- Chiropractor
- Osteopath Registered osteopath means a person registered under the Health Practitioner Regulation National Law to practise in the osteopathy. profession (other than as a student)
- Podiatrist Registered podiatrist means a person who is registered under the Health Practitioner Regulation National Law to practise in the podiatry 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).
- Neuropsychologist
- Network providers.
Agents can seek reports from referring medical practitioners if the specific treating healthcare discipline is not on the above list.
A questionnaire can be requested from a 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)..
Reasonable costs
WorkSafe can pay the reasonable costs of a THP report when requested by an Agent. THP reports can also be requested by:
- WIC Workplace Injury Commission
- the Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12 and
- other legal representatives.
See: Cost of services
Privacy and consent to give information
The worker has signed the ‘Authority to release medical information’ section of the Worker’s Injury Claim Form which the worker authorises and consents to the provider of a medical service or hospital service providing on request from WorkSafe and its Agents any information about the service relevant to the worker’s claim. Disclosure of information in accordance with the worker’s signed authority is not a breach of privacy legislation.
Provide a copy of the worker’s signed authority upon request.
Where a worker has signed the claim the form electronically, the THP may not accept the worker’s digital signature as valid. This may cause a delay in Agents obtaining medical information from the THP. If this occurs, the Agent should take steps to liaise with the THP and worker to obtain a form of signature that will be acceptable to the THP; for example, ask the worker to provide a signed authority in the THP’s preferred form.
2.7.1.1 Purpose of a THP report
A THP report can be requested to:
- determine a worker’s eligibility for initial or ongoing entitlements
- review a worker’s ongoing medical and health services
- review the management of a worker’s rehabilitation and return to work.
THP reports to determine reasonableness
THP reports are mainly used to determine whether a particular medical and like expense is reasonable, in terms of the nature and frequency of service. However, THP reports can be requested for a variety of reasons by the Agent or WorkSafe, employer, conciliation officer, medical panel or solicitor.
Preparation
Before requesting a THP report:
- gather and review relevant information on the claim file
- identify the specific purpose for requesting a THP report.
Examples
- Examples where a THP report may be requested:
- the claim is long term or becoming long term
- the worker’s RTW Return to Work capacity requires review and more than 12 months has elapsed since the worker’s first cease work date
- treatment is inconsistent with the injury or disease
- there may be more effective, alternative courses of treatment for the injury or disease
- the worker is seeking an excessive level of health services
- the worker’s treatment or services are increasing over time.
2.7.1.2 Types of THP reports
Three types of THP report templates may be used to request information. In selecting the type of report to be requested, consider the purpose of the information required.
General Practitioners can be asked to complete one of the several different types of report templates depending on the complexity and stage of the claim.
THP report templates
The three types of THP report templates for GPs are:
- Short report – contains up to three questions
- Standard report – contains up to six questions
- Comprehensive report – contains seven to 10 questions
Osteopaths and Chiropractors can be asked to complete the standard report only.
Agents should consider the reasons for a further report if there has already been a request for a report in the last 12 months.
Most relevant questions
The eform ‘Request Information from Provider’ lists the standardised template questions under three categories:
- general
- entitlement
- treatment
- return to work.
Select the most relevant questions and substitute up to three non-standardised or ad-hoc questions within the capped number of questions permissible.
Advice should be sought from the suitably qualified person (injury management) / a suitably qualified person (technical) in the selection of questions and creation of ad-hoc questions.
2.7.1.3 Medical report requested by the worker
Agents can authorise a worker or the worker’s legal representative to obtain a medical report. The facts and circumstances of each request must be assessed individually.
See: Access to Information & Privacy
Factors for authorising a worker’s request
Consider issues such as:
- who will examine the worker to provide the report and
- the relevance of the examination/report to the type of:
- injury
- entitlements sought
See: Decision making
If request is refused
If an Agent refuses to authorise obtaining a report, the Agent must write to the worker, stating the decision and the reason/s for the refusal. A refusal to pay the reasonable costs of a report is a decision not to pay a ‘medical service’ and therefore the worker must be advised of their appeal rights as in the usual course.
If request is authorised
If the Agent authorises the request, they write to the worker stating that the request is authorised and the cost of the report will be paid if the:
- cost is reasonable
- worker is entitled to compensation for medical and like expenses.
See: Pay medical & like services
If a worker obtains a medical report without authorisation
If a worker obtains a medical report without authorisation from the Agent and if:
- the claim is accepted, the worker must pay for the cost of the medical report unless the Agent makes a subsequent decision to pay for the report
- there is subsequent litigation - an unauthorised report (or a report on a denied claim) may in certain circumstances, form part of the worker’s legal disbursements.
2.7.1.4 Review & action report
The Agent requests the THP to complete and send the report within 14 days from the request date.
Once the report is received, the Agent should confirm that all questions have been addressed appropriately.
No further information required
Where there is enough information to make a decision, a letter must be sent to the worker and if relevant the THP (and the worker's GP if not the THP) advising them of the decision.
This is applicable to approval, maintain and adverse decisions.
Further information required by Agent
Where there is insufficient information to make a decision and further information is required the Agent can:
- seek advice from a suitably qualified person (injury management)/a suitably qualified person (technical)
- refer to a MA to interpret the THP report for complex or unresolved medical issues
- obtain reports from another specialist or seek information from the employer.
Report questionnaire summary
The Agent must:
- complete the eform ‘Report Questionnaire Summary’ and clearly document in Novus:
- actions undertaken and/or
- decision made
- place the THP report on the claim file
- send decision letter to the worker.
Report not received by due date
Where the THP report has not been received:
- within 21 days from the initial request date, contact the THP by telephone or send the standard letter ‘Follow-up THP Report’
- within 14 days from the date of follow-up, Consider if the THP report is still required:
- if the report is still required, a repeat contact should be made
- where the report if no longer required, the THP should be contacted immediately and advised that they are no longer required to complete the report
- if the THP refuses to complete the THP report, escalate this to a suitably qualified person (injury management)to discuss alternative actions.
Where the THP has declined to provide a report, record this in Novus and complete the ‘Seek Information from Provider’ process.
If the report has not been received and the THP has invoiced for the report, return the invoice to the provider.
Incomplete or unsatisfactory report received
If the THP report is incomplete or unsatisfactory, discuss with a suitably qualified person (injury management)/a suitably qualified person (technical).
Examples of incomplete or unsatisfactory reports include where a copy of a previous report has been re-sent or clinical notes have been submitted.
If the THP submits an unsatisfactory or incomplete report seek clarification in writing using the letter ‘Return invoice THP report’.
Note: There is no fee payable if the THP has provided insufficient or incomplete information and further information is required to make a decision.