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5.6 RTW questionnaire


5.6.1 When to use a RTW questionnaire | 5.6.2 Request completion of RTW questionnaire | 5.6.3 Agent reviews and actions questionnaire


The purpose of the RTW questionnaire is to provide clinical information to assist in the management of a worker’s timely return to work. The questionnaire also provides a tool that:

  • compensates a medical practitioner for their role in facilitating return to work
  • supports communication and engagement between the medical practitioner, worker, employer and Agent
  • supports the employer obligation to consult and obtain RTW information from the certifying medical practitioner
  • provides an avenue to clarify RTW goals by seeking information about the worker’s capacity to participate in suitable employment
  • seeks information that may be ibtained using the standard written template or verbally.

5.6.1 When to use a RTW questionnaire

The RTW questionnaire is to be used to help facilitate safe and sustainable work. It may be considered for use at the discretion of an Agent for workers where:

  • the worker has:
  • a registered (accepted or pending) time loss claim
  • at least 10 days have been paid or are payable
  • the current information on file does not provide adequate information to facilitate a safe and sustainable return to work
  • no more than one questionnaire has been requested for the same worker in a two-month period (up to a maximum of four questionnaires over 12 months).

A copy or extract of the completed questionnaire is provided to the worker and employer to support communication between key parties.

Before requesting a questionnaire the Agent considers the purpose to request the information. This could be barriers to return to work, for example recent surgery, workplace issues, or non-work related factors. If the Agent believes they already have enough information to resolve the issue then a questionnaire should not be requested.

Claim identified for RTW Questionnaire by OR provider

OROccupational Rehabilitation providers may determine that a RTW Questionnaire would assist a worker’s RTW where OR services are approved.

The OR provider should advise the Agent by phone or in writing of their intent to initiate a RTW Questionnaire. The Agent should contact the OR provider immediately if the Agent determines that a RTW Questionnaire should not be requested for that claim.

OR providers are not required to use the Agent RTW Questionnaire format, and may obtain the information verbally.

The OR provider will share the information from a completed RTW Questionnaire with the Agent either by forwarding a copy or including the information in the next OR report.

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5.6.2 Request completion of RTW questionnaire

Follow these steps to request a medical practitioner to complete a RTW questionnaire in writing.

RTW Questionnaire information may also be obtained verbally and documented as a contact on Novus.

Step Agent action
Send the request letter

When requesting the RTW questionnaire, the Agent should write to the medical practitioner:

  • use the appropriate request letter in Novus
  • enclose relevant documents, including copies of information about work duties and hours, etc. The privacy policy should be complied with at all times
  • enclose a copy of the worker’s signed Authority to Release Medical Information
  • use the most appropriate form of delivery eg mail, facsimile or email (where requested by the medical practitioner).

Send a copy of the request letter to the worker and employer to support communication between key parties.

Agent documentation

Complete the Novus task – ‘Seek Information from Provider’ and places a copy of the request letter on file.

Note: When the Novus task – ‘Seek Information from Provider’ is completed the next task – ‘Report Questionnaire Summary’ will be generated by Novus.

Receive questionnaire from THP

The THP completes the questionnaire and invoices the fee and item code specified in the request letter.

  • RTW questionnaire with employer information – Payment type 129, item number MPRTW01.
  • OR requested RTW questionnaire without employer information – Payment type 129, item number MPRTW02.
Contact medical practitioner if delay

The following procedure should be adopted where there are unacceptable delays in receipt of the questionnaire:

  • if after 14 days there is no reply to the initial request for the information, the Agent should contact medical practitioner rooms by telephone and/or send a follow-up fax

The Novus – ‘Seek Information from Provider’ task comments should indicate a follow-up phone call/letter has occurred and the due date should be updated to prompt a further follow-up if required.

  • the Agent should consider if the questionnaire is still required if, after a further 14 days, there is still no reply to the follow-up letter or receipt of information. If the report is still required, telephone the medical practitioner for an explanation and confirm the conversation with a final follow-up letter
  • if the information is no longer required, for example, if the worker has returned to pre-injury work, write to the medical practitioner cancelling their request and document this in Novus.

If the medical practitioner refuses to comply with the request discuss with a suitably qualified person (injury management).

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5.6.3 Agent reviews and actions questionnaire

The Agent reviews and documents key points and any actions to be taken relevant to the management of the claim within five working days of receiving the completed questionnaire CSW Eform attached to the ‘Record Provider Response’ task.

The Agent should:

  • note any changes or developments in the worker’s ability to return to work
  • resolve any apparent inconsistencies between the questionnaire and other information on file.

Agents should seek advice from a suitably qualified person (injury management) on interpreting the information if the issues are complex or unresolved. Agents should not read the information in isolation, as it should be compared with employer information and other relevant information on file.

Decision making

No further information or assistance required

If there is a change to the worker’s entitlements, a decision letter is sent to the worker.

Note: A copy or extract of the completed questionnaire must be provided to both the worker and employer to support communication between key parties, ensuring that the privacy policy is complied with at all times.

Further information or assistance required

Further information may be required by the Agent before making a decision about the worker’s ability to return to work. Where the questionnaire response lacks detail and does not meet the specified requirements, the Agent should discuss the information with a suitably qualified person (injury management) or MA before following up with the medical practitioner.

If the medical practitioner fails to respond to questions raised by the Agent in their request, clarification in writing should be sought by the Agent and this should be covered by the report fee which has already been paid.

Consultation associated with questionnaire

It is expected that the questionnaire provided by the certifying medical practitioner be completed on the basis of their clinical notes. A consultation is not generally expected to be a pre-requisite for the preparation of the questionnaire. If the medical practitioner believes that a consultation is required then the Agent will pay for the consultation in accordance with WorkSafe reimbursement rates.

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