This unit applies to human resources managers or specialists who manage claims and ensure that the organisation provides appropriate support for the worker.

Note that the unit does not in any way address the process of curing the worker of their injury or illness as this is the task of the health professional. Instead the unit focuses on the process of dealing with claims and ensuring that the organisation supports the worker through return to work programs.

In large organisations this work may be a full time role for some people, in smaller organisations it would typically be a part of a broader role with a human resources focus.

ELEMENT

PERFORMANCE CRITERIA

1. Analyse claims

1.1. Ensure that the organisation has and maintains a current Workers' Compensation insurance policy (or equivalent) as required by the applicable legislation

1.2. Process claims in accordance with organisational policies, and legal and insurance requirements

1.3. Dispute claims where insurer or organisational requirements are not met

1.4. Notify rehabilitation provider in accordance with organisational procedures

1.5. Advise claimants as to whether their claim has been accepted

1.6. Analyse claims to identify the nature of the illness/injury and prepare report/s

1.7. Identify projected period of absence and where rehabilitation assistance is required, and ensure arrangements are made in the work team to deal with absence

2. Establish rehabilitation/return to work program

2.1. Ensure consultation occurs between rehabilitation provider and treating doctor

2.2. Ensure consultation occurs between rehabilitation provider, relevant managers and employee

2.3. Consider job redesign, reduced hours and alternative duties in the light of medical advice

2.4. Design a rehabilitation/return-to-work program to achieve a successful return-to-work

2.5. Obtain approval for return-to-work program by relevant managers

2.6. Establish rehabilitation program with employee

2.7. Undertake risk analysis in relation to proposed program and mitigate risk where appropriate

2.8. Commence program as close to the time of the accident/illness as possible

3. Monitor/evaluate rehabilitation/ return to work program

3.1. Encourage regular feedback/communication between provider, supervising manager and employee

3.2. Organise regular contact and support between provider and employee

3.3. Identify breaches of the return-to-work program and take remedial action promptly

3.4. Refer return-to-work program to workers compensation authorities where breaches occur

3.5. Modify return-to-work program where appropriate if it is not delivering the required outcomes

3.6. Evaluate each rehabilitation/return-to-work program at its conclusion and implement recommendations for system improvement where appropriate

Required skills

communications skills to discuss health matters sensitively with a range of people and to represent the employer for disputed claims

negotiation skills to negotiate disputed claims

organisational and administrative skills to see that all claims are properly processed and that claimant is clear about what is happening and what to expect.

Required knowledge

rehabilitation concepts and return-to-work procedures

relevant legislation from all levels of government that affects business operation, especially in regard to workers compensation, occupational health and safety and environmental issues, equal opportunity, industrial relations and anti-discrimination

workers compensation tribunal procedures.

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the following is essential:

critical analysis of the organisation's rehabilitation return-to-work programs

assessment of the strengths and weaknesses of the organisation's approach to rehabilitation return-to-work programs

knowledge of relevant legislation.

Context of and specific resources for assessment

Assessment must ensure:

access to appropriate documentation and resources normally used in the workplace.

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge. The following examples are appropriate for this unit:

analysis of responses to case studies and scenarios

assessment of written reports

direct questioning combined with review of portfolios of evidence and third party workplace reports of on-the-job performance by the candidate

observation of performance in role plays

oral or written questioning to assess knowledge of workers compensation tribunal procedures

review of risk analysis undertakenof a proposed return-to-work program

evaluation of contact and support organised between provider and employee.

Guidance information for assessment

Holistic assessment with other units relevant to the industry sector, workplace and job role is recommended, for example:

other units from the Diploma of Human Resource Management.

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Claims may include:

sick leave claim/application

workers compensation claims

Rehabilitation provider may be any authorised health professional including:

case managers

counsellors or psychotherapists

pain or injury management specialists

physiotherapists

Alternative duties may include:

limited range of duties in their normal job

new position

specific tasks which will not aggravate the injury or condition

Risk analysis means:

determination of the likelihood of a negative event preventing the organisation meeting its objectives and the likely consequences of such an event on organisational performance

Mitigation means:

action taken to reduce or eliminate risk identified

Workers compensation authorities means:

relevant body, court, tribunal or commission having jurisdiction in respect to workers compensation matters

Evaluation means:

determining the extent to which the program meets its objective in respect to timeframes, success rates, cost and impact on the organisation

Unit sector

Workforce Development - Human Resource Management

This unit contains employability skills.