The meetings topic was medical approval process.
As always we got through a list of ongoing matters and updates from both iCare and the Regulator. Of note was that most of the regulations such as allowing an injured worker to access legal support when appealing a Work Capacity Decision should be in place by Mid year. That doesn’t mean it will take that long, though it might, and we certainly hope they happen sooner than that.
We also talked about the new PIAWE calculations (pre-injury average weekly earnings). These are also up for a regulation before any significant (perhaps) changes will be made but interesting to note iCare conducted a series of training sessions with the insurers and discovered “varying practices” in other words there isn’t consistency – I would therefore suggest you check your PIAWE and get the insurer or the regulator to double check if you have a concern that they aren’t doing it right.
The Regulator is reviewing all the existing guidelines and may be making more if they feel it is necessary throughout 2016 so keep checking up to see if we are doing a submission for one that interests you.
Now to the topic of the meeting. The medical approval process.
This is where you or your doctor puts in a claim for medical support (of some kind). Surprisingly the stats that we took through our survey match the stats the Regulator took in their investigation of this issue in preparation for our meeting. The majority of medical requests are approved, but take longer than 21 days to do so.
That is a ridiculous scenario and the regulator agrees. In response to both stats the regulator drilled down to find out what was going wrong. They believe that case mangers are taking the sentence “reasonably necessary” to literal. We believe they are just taking their sweet time because they can but putting that to the side the Regulator is working to provide more clarity for case managers on this which they hope will result in quicker decision making.
We put to them our preferred policy (see the attachment) and it’s not too dissimilar to theirs so we might just see a speeded up approval process in the near future (bureaucratic time rather than real time I suspect but I hope to be surprised).
The lag has a real and identifiable impact on the health of injured workers as our members who attended demonstrated through their experience. Thanks has also to go to Dr Arthur Chesterfield-Evans who attended with us to give a GP’s perspective on this matter as well.
Another side to this is the time the insurers are taking to pay medical bills in one case it took the injured worker sending back a debt collectors demand they received to the insurer to get a two year old payment settled. We recommended that the regulator (or iCare) have a dedicated complaints line for health professionals when they are not being paid on time. The Regulator will look into this.
A lot more was touched on during the meeting, IME’s private investigators, Return to work…. some of it was administrative in nature some of it was very important but without the time to go into depth but we will keep this on the radar along with those other issues.
Our next meeting in in the first week of May. We will let you know the topic and ask for your input well before that meeting.