Navigating Workcover

The Process of an Orthopaedic Injury being treated under the ReturntoWorkSA (previously WorkCover) system

At Glenelg Orthopaedics, we treat patients with a work-related injury and are more than happy to be involved in the treatment of such. A work-related injury can present in one of two ways:

1. First, there is a definite straight forward injury such as those that occur after a traumatic episode, i.e. a person falls from a height, they sustain a laceration or they feel something ‘go’ in part of their body, whilst performing a work-related activity. In these cases that have had no pre-existing problems prior, the scenario is fairly straight forward.
2. An alternative way a patient may present is with the development of slow onset of symptoms which they believe relate to work. A common scenario may be shoulder pain in someone who does a lot of overhead work and has never had pain or problems prior. These slower onset symptoms are not quite as obviously related to work.

In either case, the usual process is for the worker to report the condition to the occupational health and safety personnel or manager who reports it under the local worker’s compensation scheme (in South Australia it’s the ReturntoWorkSA). Either the person will be working for a company that is case managed by EML or Gallagher Bassett, or a company that is self-insured or is a company that is covered under a Commonwealth scheme (Comcare).

Usually, a claim will be commenced and a workers compensation Case Manager will be assigned to the worker. Usually, in order for a claim to be commenced, having reported the claim to the workplace, the worker may have either prior or subsequently sought advice from a general practitioner or a doctor (some practitioners specialise in work-related injuries). That doctor will have given advice about whether they believe it is work-related or not. In a case where time off is required, or restricted duties are recommended, the doctor will issue a Prescribed Medical Certificate outlining what duties can and cannot be undertaken, or the period of time required off work. That same doctor will coordinate further investigations such as x-rays or ultrasounds, as well as treatment plans such as referring to a physiotherapist or recommending steroid injections or referring to a specialist. This is when we become involved at Glenelg Orthopaedics.

Once I have been referred to a specialist at Glenelg Orthopaedics, what is involved?

The process involves making an appointment with Glenelg Orthopaedics, outlining to us that the condition relates to a work related injury and providing us preferably with the claim number and other details about the condition. Once an appointment is made, you will present for an opinion with a referral letter from the doctor looking after your claim, along with the results of any associated investigations. It is very important to bring along every test that has been undertaken, even if you believe they have not found any abnormal pathology, because normal tests can be just as important as abnormal tests. It can be very time consuming trying to find results online from your various providers on the day of consultation and this eats into the time available to discuss the condition.

When you are reviewed by the doctor at Glenelg Orthopaedics we will ask you what particular things make this condition work-related; we will want to hear why you think it relates to work. You will need to describe the incident where the fall occurred or how the incident happened. In the case of a chronic situation (the slow onset of the condition), why it is thought that this condition is related to work is very important, as are the details of what particular thing at work has caused the condition to come on.

Understanding why is important, not just to ensure the correct diagnosis and to determine the treatment options, but also because the surgeon assessing you will often receive a request from the Case Manager asking for an outline of why the condition relates to work. Therefore it is important to have this clear in the surgeon’s mind so this can be answered without ambiguity.

What will the surgeon do for my work-related injury?

The surgeon will, first of all, make sure that the diagnosis that has been made is correct. It is important to know what the condition is that we are treating so that you are given appropriate treatment options and treatment advice. Invariably, the referring doctor will have made the correct diagnosis but it is important that this is checked, and with the surgeon’s experience he can advise what treatment options are available.

If all non-operative treatment options have been exhausted then we may discuss surgical options. However, if there are other simpler measures to be undertaken or if the patient only wishes to have advice or reassurance of the diagnosis, then this is all that may be required.

If surgery is required, Glenelg Orthopaedics will then need to get approval to undertake the surgery. Approval starts with the patient giving consent to undertake the surgery and then the surgeon will discuss what treatment options are recommended, the risks of that treatment and the possible benefits.

No operation is risk-free and it is important that you are well aware of the possible risks. Once reassured of the options and you have decided that you wish to proceed, surgical consent is obtained by signing a consent form. If the person decides that they do not wish to proceed with surgery, consent can be withdrawn and the operation cancelled. The consent form only outlines that we have discussed the risks of the surgery. It does not force you to undergo the surgery if you do not wish to do so.

I have taken on board the surgeon’s opinion and agreed to go down the path of surgery, how do we get approval for surgery?

Glenelg Orthopaedics will then fax a request for surgery to the Case Manager for approval. In some situations, this is just a formality but in many other cases, the Case Manager will require a formal report from the surgeon to find out why they are asking to undertake surgery. This report will be requested in writing from the Case Manager and will be prepared by the surgeon, and then sent back to the Return to Work coordinator. They will outline what treatment have been undertaken, detailing all dealings with the team at Glenelg Orthopaedics including why we wish to proceed with surgery.

Reports are paid for by the team requesting the report as per standard rates set by South Australian law. Once the Case Manager has seen the report, they may wish to refer to other reports requested from other doctors or other treating specialists. The Case Manager will then decide whether the operation requested can be approved. If so, they will sign the approval form and fax this back to us at Glenelg Orthopaedics.

Once we have received this, we will inform the patient of the approval and the plan to proceed to surgery. If there is any concern about the approval being granted, contact our team and we can keep you informed of the progress.

What happens after surgery? Who will issue certificates and when will I return to work?

At the time of surgery, the surgeon undertaking the surgery will issue a Return to Work Prescribed Medical Certificate outlining the period of time off work. In many cases, it is appropriate to be off work for three to four weeks whilst one recovers from the surgery. This allows the pain to settle and the wound to improve, so that it reduces the risk of complications or additional injury caused by returning to work too early.

In the vast majority of cases, however, at three to four weeks some work duties are permissible. The ReturntoWorkSA legislation requires the doctor issuing the Prescribed Medical Certificate to outline what duties are possible. Whilst in most cases it is inappropriate to return to the pre-injury work straight away, some work will be possible in the form of light duties, using the opposite limb and reduced hours, increasing back up to full hours as tolerated.

What if no light duties are available in my workplace? Will I be signed off until I am completely recovered?

In most situations, the Case Manager or the company’s Return to Work coordinator will find some light duties for the worker to undertake. They will take into account the level of training, what options are available and, in some cases, it may involve a work hardening program where the patient is placed in a workplace outside your normal work duties. This is beyond the surgeon’s remit and he has no involvement in the plan to return to work; all that is asked of the surgeon issuing the Prescribed Medical Certificate is what duties are permissible. The Case Manager will assess the certificate and may involve a rehabilitation coordinator in the process. They will find a suitable placement. ReturntoWorkSA are keen to get all workers back to work in some capacity as soon as possible as this enhances recovery and reduces pain. As such, this is a directive provided from ReturntoWorkSA for which we at Glenelg Orthopaedics need to comply.

What if my general practitioner wants to issue Prescribed Medical Certificates?

This is ideal. At Glenelg Orthopaedics we are more than happy to issue the initial Prescribed Medical Certificate that covers the initial few weeks off work. We then involve the general practitioner or doctor specialising in Return to Work conditions to take over the issuing of Prescribed Medical Certificates. The actual condition may take more than a few months to recover after the surgery and in the majority of cases will continue to improve for six to twelve months following surgery. However, the surgeon undertaking the surgery may only see the patient four to six times following surgery, less for more simple cases, in which case the general practitioner keeping an eye on the patient is in a better situation to issue Prescribed Medical Certificates.

What is the process for being signed back to full duties? Does this mean the claim is now closed?

There are three different elements to recovery from surgery or from a work-related injury without surgery. The first is returning to full duties, which can occur with or without continuing symptoms. The second is full resolution of the condition, which is the aim. The third is maximum medical improvement, as is the case when for all intents and purposes the condition has improved as much as possible but there may be some continuing symptoms.

Obviously, the aim is to have full resolution of symptoms and return to full duties. However, return to full duties can occur before all symptoms have resolved and often getting back to normality helps the last element of continuing symptoms settle, as it takes the mind off the condition itself.

Returning to full duties does not mean the claim is closed. If the patient returns to full duties and all symptoms resolve then the claim can be closed. If the patient continues either on reduced duties or full duties but with continuing symptoms, treatment can continue. Eventually, however, they reach a point where no further treatment is possible. One would hope that the patient has had full resolution of symptoms, but if not, then they would have been taught some exercises or techniques to help control or manage their symptoms.

In the vast majority of cases these symptoms may not bother the patient significantly. Once maximum medical improvement has been achieved or if the time period for which a work-related claim is allowed to remain open is reached then the case comes to closure. If symptoms continue you may be asked whether you wish to seek a permanent impairment assessment.

In some scenarios there may be an option for further surgery at a later date, in which case it is important to notify the Case Manager that this is an option and see if pre approval can be obtained.

If the case is closed and symptoms continue then you may wish to seek a permanent impairment assessment. This involves a formal process where, in most cases, an independent medical doctor will assess you to determine how much impairment you are suffering so as to determine a level of final payout for your condition. Impairment assessment is undertaken in a standardised fashion and Dr Nimon at Glenelg Orthopaedics is authorised and trained to undertake such assessments, although most of the time the Case Manager will seek an independent assessor.

Impairment assessment involves the use of standardised techniques as dictated by the American Medical Association 5th Edition Guidelines and any impairment often involves an hour consultation time as preparation for the report. As such the ReturntoWorkSA process is quite detailed and extensive.

At Glenelg Orthopaedics we are well trained to deal with such a pathway. We always believe information to the patient is vital and as such if you have any questions or concerns, feel free to discuss it with us at Glenelg Orthopaedics. For further advice about your work-related injury call us on 08 8376 9988.

Glenelg Orthopaedics – providing quality orthopaedic care