4.5.20.2 Reviews request

The Agent reviews the treating health professional request along with the tools for household help decision making. All available information on the claim file should be considered when determining the worker’s functional capacity and entitlement for household help services, including:

• treating practitioner reports
• independent medical examination reports
• any previous ADL Activities of daily living(OT 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 .) assessments

• current living situation i.e other adults residing at premises

• workers expected recovery timeframes

• adaptive equipment needs or requests

• file notes on ACCtion and Novus

Further information required

If further information is required:

• contact the worker or the requesting treating health professional
• send a standard letter seeking further information (MSR4) to the treating health professional
• request an ADL (OT) assessment

WorkSafe approved services

Agents should refer to the Household Help policy and the following lists to determine if the type of household services requested have been approved by WorkSafe:

• Housework tasks authorisation lists and cost/service guidelines
• Gardening tasks authorisation lists and cost/service guidelines

Exceptions: Any request for services not listed within the checklists must be discussed with a suitably qualified person and referred to WorkSafe's Claims Division

The Agent should consider the following criteria when assessing whether a service is reasonable and appropriate for the worker:

• the relationship of the injury or illness to the requested service
• whether the service is for the worker
• whether the worker undertook the tasks pre-injury
• the worker’s ability to undertake the tasks post injury
• the size of the worker’s home/garden at the time of the injury
• the worker’s family circumstances
• the reasonable contribution of family/household members.

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Adverse decisions

If information indicates the worker is not entitled to household help services (eg service is not related to the injury) or the request is for a household service which is not approved by WorkSafe (eg car washing), the Agent should reject the request.

Short-term household help

The Agent can approve household help without an ADL assessment where the worker:

• is eligible for household help services
• the expectation has been set with the worker that this assistance is typically in place for a short period of time while the worker increases their independence
• the treater has indicated a reasonable period expecting to regain independence in this activity
• the level of services being requested is reasonable given information provided
• was recently injured or has recently had surgery
• has not been paying for household help services prior to injury.

To determine complex household help requirements the Agent may consider arranging an ADL (OT) assessment.

If an Agent is unsure of a worker’s injuries or capacity or the worker has a complex social situation, the Case Manager should speak to a suitably qualified person (injury management) about arranging an ADL (OT) assessment to determine any household help.

See: Short-term household help services ready reckoner

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Approve short-term household help

If the request is greater than the outline in the table below the Case Manager will require documentation to support an alternative arrangement.

• housework
  

  Option	Hours of service	Frequency	Duration	Total # of sessions/hours	Rates
  House work	2 hours per session	Fortnightly	6 - 12 weeks	Up to 6 sessions / 12 hours	As per WorkSafe fee schedule

• lawn mowing/gardening
  

  Option	Hours of service	Frequency	Duration	Total # of sessions/hours	Rates
  Option C Summer (1 Oct – 31 Mar)	As per quote	Fortnightly	12 weeks	6 sessions	Gardening – As per WorkSafe fee schedule Lawn mowing – as per quote
  Option D Winter (1 Apr – 30 Sept)	As per quote	Monthly	12 weeks	3 sessions	Gardening – As per WorkSafe fee schedule Lawn mowing – as per quote

Note: Lawn mowing quotes must be reasonable. Lawn mowing is only applicable for the residential area of a worker’s property.

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