3.3.5 After the second entitlement period Post second entitlement period review | Additional services after 130 weeks | Application for weekly payments after the second entitlement period - incapacitated due to surgery | Application for weekly payments after second entitlement period – returned to work | Ongoing management post second entitlement period | Six monthly reviews

A worker’s entitlement to weekly payments ceases after the expiry of second entitlement period unless:

A worker can apply to continue to receive weekly payments after the expiry of the second entitlement period if they are incapacitated due to surgery or have returned to work, subject to meeting the criteria.

See: Application for weekly payments after second entitlement period – incapacitated due to surgery | Application for weekly payments after second entitlement period – returned to work

After the expiry of the second entitlement period the Agent and self-insurer must continue to review the claim to determine the worker’s ongoing entitlement and that the worker’s capacity has not changed since the last review. Post second entitlement period review

A review of a worker’s capacity, rehabilitation progress and future employment prospects is to occur after the expiration of the second entitlement period. The review can be conducted at any time and as often as may be reasonably necessary. There is however a requirement for an assessment to occur at least once every two years.

Case conference

Topics for discussion at the conference should include the pre-conference review findings and may include but are not limited to:

  • current treatment regime and appropriateness
  • capacity for employment
  • rehabilitation progress
  • future employment opportunities and
  • retraining options.

The conference attendees (minimum of two) should agree and determine appropriate actions and strategy to be undertaken in line with the review findings and conference discussions.

Two year review

A full review must be conducted as often as may be reasonably necessary but at least every two years to assess the worker’s ongoing entitlement to weekly payments.

Note: for workers who reached 130 weeks on or after 31 March 2024, their whole person impairment (WPI) is not re-assessed unless:

At each review assess:

  • if the worker is still incapacitated for work
  • if the worker’s incapacity for work is still materially contributed to by the injury/injuries for which liability is accepted
  • the worker’s rehabilitation progress
  • the workers future employment prospects
  • if the injury suffered was a temporary aggravation of an underlying or non work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. condition, the review must also consider if the effects of the aggravation have ceased
  • whether incapacity is affected by any and what non-work related conditions, or any subsequent work injuries (arising from a different claim)

  • medical and like services for appropriateness and relationship to the work-related injury.

The Agent or self-insurer can undertake a review before the mandatory two years if reasonable and/or necessary, for example:

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Conduct review

Agents and self-insurers need to obtain all necessary up to date information in order to conduct a thorough review and make an informed decision on the worker’s ongoing entitlements such as:

A properly conducted review will also identify any gaps or missing information for follow up.

Agents and self-insurers are required to develop a strategy/plan to assist the worker to return to work where possible as part of the review.

Review findings

A worker’s capacity may have changed since the last review. This includes workers who since the last review:

Medical and like services are also reviewed to ensure there is still an ongoing entitlement to these services for the accepted injury. Consider:

  • appropriateness of treatment and medications
  • the frequency and amounts are appropriate
  • if home help, aids and appliances are still necessary.
Alteration to entitlement

The review findings may establish:

  • no ongoing entitlement to either weekly payments and/or treatment
  • an alteration to a current entitlement to weekly payments or treatment
  • no change to any entitlements

If the Agent or self-insurer decides to alter or terminate weekly payments or treatment, they must send a notice to the worker and employer, if applicable, ensuring:

  • all criteria is addressed before terminating and
  • the correct notice period is given.
Advise THP

The Agent or self insurer advises the THP if the review has identified a need for:

  • increased treatment
  • other beneficial treatments or
  • further investigations

Identified increases in home help or aids through independent assessments are to be made as soon as practicable, as long as guidelines are met.

See: A-Z of medical & like services

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