Safety, Rehabilitation and Compensation Act 1988

Section 34S

 

 

APPROVAL OF FORM OF APPLICATION FOR APPROVAL AS A WORKPLACE REHABILITATION PROVIDER (REHABILITATION PROGRAM PROVIDER)

 

 

Comcare, pursuant to section 34S of the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act), with effect on and from 1 January 2013 and for the purposes of paragraph 34C (1)(a) of the SRC Act (approved form for Application for Approval as a Rehabilitation Program Provider):

 

1. revokes the instrument dated 30 October 2009 registered as  instrument  F2009L04154 on the Federal Register of Legislative Instruments; and

 

2. approves the attached form (Application for Approval as a Workplace Rehabilitation Provider (Rehabilitation Program Provider)).

 

 

Dated:     17 October 2012

 

 

The seal of Comcare was affixed 

in the presence of:

 

 

 

 

 

Steve Kibble

Deputy Chief Executive Officer

 

Attachment: Form for application for Approval as a Workplace Rehabilitation Provider (Rehabilitation Program Provider) – 27 pages.

 

Safety, Rehabilitation and Compensation Act 1988

Sections 34C and 34S

 

 

 

 

 

 

Application FOR approval
as a Workplace Rehabilitation PROVIDER
(rehabilitation PROGRAM provider)

 

 

 

 

 

 

 

 

 

 

 

This application form has been approved under section 34S of the Safety, Rehabilitation and Compensation Act 1988 for the purposes of section 34C of that Act.  It is to be completed by applicants seeking initial approval as a Workplace Rehabilitation Provider (Rehabilitation Program Provider) under that Act.

This application should be read in conjunction with the document Guide: Nationally Consistent Approval Framework for Workplace Rehabilitation Providers”, and the Comcare Approval Criteria and Operational Standards.

 

Contents

 

Application FOR approval as a Workplace Rehabilitation Provider (rehabilitation PROGRAM provider)

In this application form:

Introduction

Information to complete the application

Application requirements

Comcare application lodgement

Part A – Applicant details

Part B – Conforming to the Conditions of Approval

Appendix 1 - Staff details

Appendix 2 - Statement of commitment to the Conditions of Approval

Appendix 3 - Statement of commitment to the Code of Conduct for Workplace Rehabilitation Providers

Appendix 4- Comcare Agreement and Authorisation

In this application form:

‘Applicant’ includes:

(a) a sole trader;

(b) a partnership; or

(c) a company

‘Code of Conduct’ means the HWCA endorsed Code of Conduct for Workplace Rehabilitation Providers in Appendix 4 of the Guide, as at 1 July 2012

‘Conditions of Approval’ means any section 34F, 34L or 34P SRC Act conditions of approval imposed on an approved Workplace Rehabilitation Provider. These conditions include, as standard, the National Conditions of Approval

‘Criteria for Approval’ and ‘Approval Criteria’ mean the Criteria for the Approval or Renewal of Approval as a Workplace Rehabilitation Provider (Rehabilitation Program Provider) from time to time in force under section 34D of the SRC Act

‘Guide’ means the HWCA document “Guide: Nationally Consistent Approval Framework for Workplace Rehabilitation Providers” published on the HWCA website www.hwca.org.au as at 1 July 2012

‘Employer’ means the Entity, Commonwealth Authority or Licensed Corporation employing the employee

Note: The expressions Entity, Commonwealth Authority and Licensed Corporation are defined by subsection 4(1) of the SRC Act

‘HWCA’ means the Heads of Workers’ Compensation Authorities

‘Jurisdiction’ means the relevant Workers’ Compensation scheme for that state/territory

‘National Conditions of Approval’ means the HWCA endorsed National Conditions of Approval as contained in the Criteria for Approval

‘Operational Standards’ means the Operational Standards for Workplace Rehabilitation Providers (Rehabilitation Program Providers) from time to time in force under section 34E of the SRC Act

‘Prescribed fee’ means the fee prescribed by the Safety, Rehabilitation and Compensation Regulations 2002

‘Principal’ has the same meaning as that term is defined in section 34 of the SRC Act, namely:

(a)  if the applicant is a partnership—any of the partners, and

(b)  if the applicant is a company—any of the directors of the company and, if the person responsible for the day to day running of the company is not a director, also that person

‘Principles of Workplace Rehabilitation’ are the principles set out in Appendix 1 of the Approval Criteria and are the HWCA endorsed Principles of Workplace Rehabilitation

‘Provider’ means a person (including a partnership or company) that is approved as a Workplace Rehabilitation Provider (Rehabilitation Program Provider) under the SRC Act, and includes any principal of the provider

‘Rehabilitation Program Provider’, ‘Provider’, ‘Workplace Rehabilitation Provider’, and ‘WRP’ have the same meaning

‘SRC Act’ means the Safety, Rehabilitation and Compensation Act 1988

‘Workers’ Compensation Authority’ means the body responsible for the administration of Worker’s Compensation Legislation in any jurisdiction.  Comcare is the Workers’ Compensation Authority for the federal jurisdiction

‘Workplace rehabilitation’ is a managed process involving timely intervention with appropriate and adequate services based on assessed need, and which is aimed at maintaining injured or ill workers in, or returning them to suitable employment. (NOHSC: 3021 (1995), Guidance notes for Best Practice Rehabilitation Management of Occupational Injuries and Diseases, April 1995)

‘Workplace Rehabilitation Model’ is a service delivery model for workplace rehabilitation:

(a) aimed at an early and safe return to work for injured employees

(b) involving a designated provider responsible and accountable for coordinating services designed to achieve a cost-effective, safe and durable return to work for the injured employee

(c) where services are delivered on a continuum of assessment of need, planning, active implementation, review and evaluation

(d) requiring effective communication, decision making, financial accountability and informed purchasing of services and resources

Notes:

  1. Authentic copies of the Guide (including the Code of Conduct) are published on the HWCA and Comcare websites at www.comcare.gov.au  and www.hwca.org.au.
  2. Authentic copies of the Approval Criteria and the Operational Standards are available on the Federal Register of Legislative Instruments as www.comlaw.gov.au  and the Comcare website at www.comcare.gov.au .  The Approval Criteria and the Operational Standards are disallowable legislative instruments within the meaning of the Legislative Instruments Act 2003.

Introduction

The Heads of Workers’ Compensation Authorities (HWCA) endorsed a nationally consistent framework for the approval of Workplace Rehabilitation Providers in June 2008.  The details of the approval framework are contained in the HWCA document “Guide: Nationally Consistent Approval Framework for Workplace Rehabilitation Providers”. 

Applicants should ensure they fully understand the framework contained in the Guide prior to making an application to become a Workplace Rehabilitation Provider.

Applicants should also refer to the Comcare Approval Criteria and Operational Standards to ensure that they are aware of all the criteria that must be satisfied to be approved as a Workplace Rehabilitation Provider.

If the application is successful, an Instrument of Approval as a Workplace Rehabilitation Provider will be issued for a 3-year period, until 30th June of the third year.

Information to complete the application

  1. A completed application must be submitted using this application template to the Workers’ Compensation Authority in the jurisdiction where approval is sought and be accompanied by the prescribed fee, where appropriate. 
  2. Applicants should refer to the appropriate website of the Workers’ Compensation Authority to confirm the email and/or address details where the application must be lodged and what application fee may apply.
  3. Applicants should ensure their application contains sufficient information and is accompanied by the necessary supporting documentation to demonstrate their capacity to meet the Conditions of Approval (see the Guide, section 6 – Conditions of Approval).
  4. The Workers’ Compensation Authority will approve an application where it is satisfied that the applicant conforms to the Conditions of Approval and any other criteria contained in the Approval Criteria.  If an applicant is successful, the Workers’ Compensation Authority will inform the applicant of its decision by issuing an Instrument of Approval for a 3-year period.
  5. An Instrument of Approval is issued for a maximum period of 3 years, until 30 June of the third year. In order to continue to provide services beyond this date a Workplace Rehabilitation Provider will be required to make a renewal application within the third year as prescribed by the Workers’ Compensation Authority where renewal of approval is sought.
  6. During the 3-year approval period, the Workplace Rehabilitation Provider will participate in annual self-evaluations and any independent evaluation as required by the worker’s compensation authority to determine conformance with the Conditions of Approval.
  7. Should an application not conform to all the Conditions of Approval, the applicant will be given an opportunity to provide further information. Subsequent to this, if the applicant still does not conform to all the Conditions of Approval then the application is considered to be unsuccessful.
  8. If an application is unsuccessful, the applicant will be advised of the reasons and the appeals process relevant to the Workers’ Compensation Authority.
  9. An applicant that has been unsuccessful in their application will not be eligible to apply for approval until they can demonstrate to the Workers’ Compensation Authority’s satisfaction that the reasons for non-approval no longer exist.
  10. The provision of false or misleading information is a serious offence and will nullify the application.

Application requirements

The application must be accompanied by the prescribed fee and the following requirements that must be completed to demonstrate how an organisation will conform to the Conditions of Approval and any other criteria for approval.

  1. Applicant details including:
    • Business ownership details including association or connection with other organisations supplying services within the Workers’ Compensation industry (Part A)
    • Current details of their model of workplace rehabilitation service delivery (Part B)
    • Documentation demonstrating how the applicant meets the Conditions of Approval (Part B)
  2. A signed Statement of Commitment to the Conditions of Approval (Appendix 2)
  3. A signed Statement of Commitment to the Code of Conduct for Workplace Rehabilitation Providers (Appendix 3)
  4. Current staff details completed for each location where workplace rehabilitation services may be delivered in the event that the application is approved (one sheet per location/state) (Appendix 1)
  5. Any other documentation or information requested by the Workers’ Compensation Authority as part of considering the application
    • Comcare additional application requirements (Part C)
    • Comcare agreement and authorisation (Appendix 4)

While considering an application, the Workers’ Compensation Authority may at any time request further information in writing from the organisation and may liaise with other Workers’ Compensation Authorities where the provider delivers workplace rehabilitation services to exchange information about the application.

Comcare application lodgement

Comcare will publish of the application lodgement details on its website at www.comcare.gov.au .

The application must be accompanied by the prescribed Comcare initial application fee and the form is available on the Comcare website.

Comcare enquiries:

Phone:   1300 366 979

Email:  rehab.approval@comcare.gov.au

Address: Rehabilitation provider approval team

  Comcare

  GPO Box 9905

  Canberra ACT 2601

Website: www.comcare.gov.au

 

Part A – Applicant details

Name of the Workers’ Compensation Authority where this application is being submitted to:

COMCARE

  1. Business Name

 

2.         ABN and origin

Attach copy of the ABN record from the Australian Business Registry.

3.         Organisation

Indicate the nature of your organisation (i.e. company, partnership, sole trader, individual subsidiary of a Government body)

 

Full name of your organisation including trading name

 

ACN:

 

Name and address of any parent organisation, if applicable.

 

Name(s), position, and contact details of Principal/Partners/Managing Director etc.

 

Name and position of person/s authorised to sign this application on behalf of the organisation.

4.         Addresses

Organisation Address

 

 

Postal Address

 

5.         Phone Number

 

6.         Fax

 

7.         Email

 

8.         Contact person for this application

Name

Title

Phone

Email

 

9.         Name of person/s who meet the organisational management structure requirements as outlined in Part B, Principle Two: Organisational & administrative arrangements in particular sub-principle 2.5 of this form.

Name/s

 

Titles

 

Qualifications and workplace rehabilitation experience of the person/s meeting this requirement

 

Phone

Email

10.     Other Workers Compensation Authorities where approval has been granted.

List the jurisdictions in which the applicant has a current Instrument of Approval.

11.     Referees

Provide the contact details of two referees who can attest to your organisation’s suitability as a Workplace Rehabilitation Provider organisation including statements as to the professional integrity, honesty and due diligence of your organisation’s owner/s and/or management.

 

 

 

 

12.     Previous Applications

Has your organisation, any of its owner/s and/or management and/or any persons employed or engaged to deliver workplace rehabilitation services by your organisation been refused approval as a provider of rehabilitation services or had approval been withdrawn as a provider of rehabilitation services in any Australian Workers’ Compensation jurisdictions?

       Yes          No

If so, provide details of the circumstances and reasons why there is no cause to reject your organisation’s application.  These details should state whether the refused approval was associated with:

  1. Your organisation, or
  2. Any of its owner/s, or
  3. Any of its management, or
  4. Any of its employees including contractors and staff.

 

13.     Conflict of Interest

Detail all your organisation’s business affiliations with other suppliers of services within any of the Workers’ Compensation Authorities and how you will manage any actual or perceived conflict of interest.

[refer to the Jurisdictional Policy Advice JPA 2003/03 on the Comcare website]

 

14.     Professional misconduct or criminal proceedings

Outline if any proceedings have been taken (or are pending) against any of the following, in relation to professional misconduct or criminal proceedings, breaches of the privacy act or financial administration acts.  If so, provide details of the circumstances and reasons why there is no cause to reject your organisation’s application.  These details should state whether the circumstances and reasons was associated with:

  1. Your organisation, or
  2. Any of its owner/s, or
  3. Any of its management, or
  4. Any of its employees including contractors and staff.

 

 

15.     Insurance Documents as outlined in Part B, Principle Two: Organisational & administrative arrangements in particular sub-principle 2.1 of this form.

In the context of workplace rehabilitation service provision, please attach copies of your organisation’s:

  1. Professional Indemnity Certificate of Currency
  2. Public Liability Certificate of Currency
  3. Workers Compensation Certificate of Currency

 

 

 

 

Part B – Conforming to the Conditions of Approval

An application must demonstrate how the applicant will conform to the Conditions of Approval.

Principle One: Service provision

  1. Expectations that a return to work goal and the services required are established with relevant parties at the commencement and throughout service provision (relevant parties include worker, employer, insurer, other service providers).
  2. Appropriate services are identified and delivered to maximise return to work.
  3. Services focus initially on return to work in the worker’s pre-injury employment or, if that is not possible, with another employer.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.  For example consider what would you say to an injured worker or an employer about what this means and what will occur.

 

 

 

 

 

 

 

  1. Workers receive prompt attention and intervention appropriate to their needs.
  2. Barriers, risks and strengths are identified and strategies promptly implemented.
  3. Services are actively coordinated and integrated with other injury management and return to work activities.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators. For example consider what would you say to an injured worker or an employer about what this means and what will occur. 

 

 

 

 

 

 

 

  1. Needs of the worker and employer are identified by means of adequate and appropriate assessment.
  2. Service levels match the worker and employer needs.
  3. Service costs match the range and extent of service provision.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators. For example consider what would you say to an injured worker or an employer about what this means and what will occur.

 

 

 

 

 

 

 

 

 

  1. Respectful, open and effective working relationships established and maintained with and between workers and employers and other relevant parties.

b.       The provider acts as the link between treatment providers and the workplace to translate functional gains into meaningful work activity.

c.       Progress towards the return to work goal is communicated to interested parties throughout service provision.

d.       Durability of employment is confirmed 13 weeks after placement. [for Comcare refer to the Operational standards- Outcome standard requirement]

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators. For example consider what would you say to an injured worker or an employer about what this means and what will occur. 

 

 

 

 

 

 

 

 

a. Assessments demonstrate need for service.

b.       The type of service selected is the most appropriate and cost effective of those available to achieve the return to work goal.

c.       An equitable and consistently applied approach to recommending commencement and cessation of service delivery.

d.       Consideration given to workplace industrial relations and human resource matters that may affect the worker’s return to work.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators. For example consider what would you say to an injured worker or an employer about what this means and what will occur.

 

 

 

 

 

 

 

 

Principle Two: Organisational & Administrative arrangements

  1. Systems of probity that avoid conflict of interest as well as prevent, manage and report malpractice/fraud.
  2. Appropriate financial administration including accurate accounting.
  3. Maintenance of appropriate and adequate insurances, including professional indemnity, public liability and workers’ compensation.
  4. Data collection, analysis and reporting of provider performance including return to work and durable return to work rates.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

  1. Comprehensive, accurate and accessible records pertaining to all clients, staff and business operations.
  2. Security of storage of records in accordance with legislative requirements.

Provide a succinct statement on how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

  1. Systems that incorporate privacy and confidentiality requirements within all aspects of the organisational and administrative arrangements.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

  1. Systems that comply with relevant injury management and workers compensation legislation.
  2. Systems that comply with local workplace health and safety legislation.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

  1. At least one person in the management structure with a qualification recognised as being sufficient to satisfy the requirements of a Workplace Rehabilitation Consultant and who is able to demonstrate at least five year’s relevant workplace rehabilitation experience (also refer to 4.1.a. Minimum Workplace Rehabilitation Consultant qualifications).

Provide a certified copy of the qualifications and experience of the personnel who meet and will continue to meet this condition.

 

 

 

 

 

 

 

 

 

 

 

 

Principle Three: Quality Assurance & Continuous Improvement

  1. Quality systems that ensure customer focused service delivery, and collect, analyse and monitor qualitative and quantitative data to identify areas of strength and opportunities for systems and service improvement.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

  1. Implementation of appropriate review mechanisms (e.g. annual self evaluations and internal peer reviews) to assure conformance with the Conditions of Approval.
  2. Implementation and documentation of corrective and preventative actions and monitoring and review of their effectiveness.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

  1. System to collect, review, analyse and action solicited and unsolicited feedback from customers.
  2. Implementation of an effective complaints management system.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

 

  1. Systems for analysing information and data to identify opportunities for improvement.
  2. Planning, piloting, refining and implementing improvement strategies.
  3. Monitoring and review the effectiveness of any improvement strategies.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

 

 

 

Principle Four: Staff Management

  1. Systems for ensuring that Workplace Rehabilitation Consultants have the minimum qualifications (as outlined below) and the qualifications are verified.
  1. Workplace Rehabilitation Providers (including those consultants employed or engaged by them) will have a qualification that is recognised, accredited or registered by one of the following associations or Australian Health Practitioner Regulation Agency registration boards (however described) –
    1. Rehabilitation Counsellor- Australian Society of Rehabilitation Counsellors (recognised) Rehabilitation Counselling Association of Australia (recognised),
    2. Occupational Therapists Board (registered),
    3. Physiotherapist (registered),
    4. Exercise Physiologist-Exercise & Sports Science Australia (accredited as Exercise Physiologist),
    5. Psychologist (registered),
    6. Speech Pathologist- Speech Pathology Australia (recognised),
    7. Social Worker- Australian Association of Social Workers (recognised),
    8. Medical Practitioner (registered),
    9. Nurse (registered)
    10. Any other professional group assessed as meeting the HWCA requirement.

And has 12 months or more experience delivering workplace rehabilitation services.

ii.      Where a Workplace Rehabilitation Provider has less than 12 months experience delivering workplace rehabilitation services, a comprehensive induction program will be completed and professional supervision provided for at least 12 months.

Notes-

  1. Some workplace rehabilitation services can only be delivered by designated professional groups.  The minimum qualifications to deliver these services are included in the description of the workplace rehabilitation services, as specified by each jurisdiction.
  2. A workplace rehabilitation consultant will be taken to satisfy 4.1(a) if they will be eligible for full membership on completion of a current period of required supervised professional practice (as determined by the relevant Professional Association or Registration Board).

b.       has appropriate skills, knowledge and experience to deliver workplace rehabilitation services; and

c.       has knowledge of injury management principles and workers’ compensation legislation, policy and procedures; and

d.       all Workplace Rehabilitation Providers and other staff interfacing with injured employees and their employers and workplaces have appropriate and required checks and clearances, such as child protection, occupational health and safety, police and security.

Your organisation must provide a completed Staff Details sheet - for each location being proposed as part of this application (see Appendix 1 - Staff details).

Provide a succinct statement on what this means to your organisation and how you will apply this principle with particular reference made to indicators b. c. and d.

For each consultant seeking Comcare approval you will need to complete the Comcare Workplace Rehabilitation Provider (consultant) approval form and submit the relevant documentation to Comcare in support of their application. This form is available from the Comcare website.

 

 

 

 

 

 

 

 

 

 

 

 

  1. A robust induction and continuous learning and development program to support the acquisition and maintenance of staff skills and knowledge.
  2. Staff have access to and understand all current policies and procedures relevant to their work.

c.       Staff having appropriate supervision and support and participate in internal peer review processes.

d.       Staff members are compliant with the professional Code of Conduct relevant to their particular qualification.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

 

 

 

  1. Caseload management systems that efficiently allocate cases to staff with the experience and skill level to match the worker’s injury, needs and potential case complexity.
  2. Handover practices where cases are reviewed and all relevant parties informed to maintain continuity of care for the worker.

Provide a succinct statement on what this means to your organisation and how you will apply this principle and its indicators.

 

 

 

 

 

 

 

 

 

To demonstrate ongoing conformance with the Conditions of Approval, an organisation must participate in annual self-evaluations and any independent evaluations as required by the Workers’ Compensation Authority.

[The current self-evaluation tool ‘Workplace Rehabilitation Provider Evaluation tool is available from the HWCA and Comcare websites.  For Comcare, a representative sample of Comcare cases must be reviewed as part of the self-evaluation process].

Outline the annual self-evaluation procedures and processes that will be implemented in the context of your organisation’s quality assurance model. Confirm your organisation’s agreement to conduct annual self-evaluations.

Please outline how the organisation will ensure that the person(s) who will conduct the provider annual self-evaluations on behalf of the organisation meet the requirements of an independent evaluator including their qualifications. Please confirm what steps will be taken to ensure they will not personally be responsible for the aspects of the business that they evaluate. Confirm your organisation’s agreement to participate in independent evaluations as required by the Workers’ Compensation Authority.

 

 

 

 

 

 

 

An organisation must demonstrate management of 12 cases of activity consistent with the model of workplace rehabilitation within any workers’ compensation jurisdiction. (Due consideration will be given to organisations servicing rural and remote areas).

[For Comcare this includes details of rehabilitation activity under the SRC Act (for ACT Government, Commonwealth Government and Licensed Self Insurers), and under Military Compensation or Seacare legislation.  To be eligible to renew their approval at the end of this current approval period the provider must also meet Criterion 4- Renewal of Approval Only- requirements, of the Approval Criteria, from time to time in force under s34D of the SRC Act]. 

Outline how your organisation will meet this condition. 

If your organisation is currently approved as a provider of workplace rehabilitation services for a Workers’ Compensation Authority, please attach current case data to illustrate conformance with this requirement at this time.

 

 

 

 

 

The Workplace Rehabilitation Provider must maintain the minimum return to work rate as set by the Workers’ Compensation Authority.

[For Comcare renewal the provider must meet the Outcome Standards contained in the Operational Standards].

Outline how your organisation will meet and maintain the minimum return to work rate.

If your organisation is currently approved as a provider of workplace rehabilitation services for a Workers’ Compensation Authority, please attach current performance data to illustrate what return to work rates are being achieved at this time.

 

 

 

 

 

 

 

 

The Workplace Rehabilitation Provider’s facilities at all locations where services are intended to be provided must provide an accessible and appropriate environment for workers, staff and visitors and comply with local workplace health and safety legislation.

List each location/site.

For each location/site describe how the facilities are accessible and appropriate for all workers, staff and visitors.  In your response detail:

For each location/site describe how the facilities comply with local workplace health and safety legislation.

 

 

 

 

 

 

 

 

 

Part C- Comcare initial application requirements

Provide a reference from an independent, qualified person, such as accountant or bank manager, to attest to the financial viability of the applicant.

Please attach document.

 

Providers must achieve and maintain the Operational Standards (outcome and service delivery standards) for Workplace Rehabilitation Providers determined under section 34E of the SRC Act.

Please provide a succinct statement addressing how the applicant will meet the Operational Standards- Service standards for ‘Rehabilitation assessment’, ‘Rehabilitation program,’ and ‘Service costs’.

 

 

 

 

 

 

 

 

List the range of services offered by the applicant.

Please list the services provided.

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 1 - Staff details

Staff details sheet completed for each location in the jurisdiction where the application is submitted and where workplace rehabilitation services may be delivered. 

ORGANISATION:

 

 

 

 

ADDRESS*:

 

DETAILS AS AT DATE:

Name and position title

Qualifications

include: qualification, institution, year of concurrence e.g. B.App Sci. OT Syd Uni – 1991

Years of Workplace Rehabilitation
Experience

Basis of
Employment
(e.g. fee-for-service, part time
or full-time)

Professional Membership or registration (Type and membership number)

Supervision arrangements for staff with less than 12 months experience.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Duplicate this page and table for each location in the jurisdiction where the application is submitted.  Add more rows to this table if needed to list all staff members.

 

 

Appendix 2 - Statement of commitment to the Conditions of Approval

A reference to the Workers’ Compensation Authority is a reference to the Workers’ Compensation Authority who issued the Instrument of Approval.

The Conditions of Approval are:

  1. The Workplace Rehabilitation Provider must comply with the Principles of Workplace Rehabilitation.

Note: The Principles of Workplace Rehabilitation are set out in Appendix 1 of the Approval Criteria.

2.       The Workplace Rehabilitation Provider must ensure that all services are delivered in accordance with the workplace rehabilitation model by persons who hold the minimum qualifications as defined in the Principles of Workplace Rehabilitation and in accordance with service descriptions appropriate to the Workers’ Compensation Authority where the approval is being sought.

3.       The Workplace Rehabilitation Provider’s management structure must include at least one person who holds a rehabilitation consultant qualification outlined in the Principles of Workplace Rehabilitation and who is able to demonstrate 5 years’ relevant workplace rehabilitation experience.

4.       The Workplace Rehabilitation Provider must participate in annual self-evaluations and in independent evaluations as required by the Workers’ Compensation Authority to demonstrate conformance with the Conditions of Approval.

5.       The Workplace Rehabilitation Provider must demonstrate management of 12 cases of workplace rehabilitation within any workers’ compensation jurisdiction for each 12 month period within the 3 year approval period. (Due consideration will be given to providers servicing rural and remote areas).

6.       The Workplace Rehabilitation Provider must maintain the minimum return to work rate as set by the Workers’ Compensation Authority.

Note: The minimum return to work rate is set out in the Operational Standards.

7.       The Workplace Rehabilitation Provider must provide data to the Workers’ Compensation Authority consistent with the Conditions of Approval.

8.       The Workplace Rehabilitation Provider must deliver services in compliance to the Code of Conduct for Workplace Rehabilitation Providers.

9.       The Workplace Rehabilitation Provider’s facilities at all locations where services are delivered must provide an accessible and appropriate environment for workers, staff and visitors and comply with local workplace health and safety legislation.

10.   The Workplace Rehabilitation Provider must remain financially solvent.

11.   The Workplace Rehabilitation Provider must notify the Workers’ Compensation Authority in advance, or as soon as practical, if any of the following situations arise and accept that the Workers’ Compensation Authority will review the status of approval and determine whether the proposed arrangements conform with the Conditions of Approval:

  1. the business is sold or the controlling interest in the business is taken over by a new shareholder(s), owner(s) or director(s).
  2. the business changes its trading name or location of premises.
  3. the business supplies or has connections with other suppliers of services within the workers’ compensation industry.
  4. a new chief executive officer or director or head of management is appointed.
  5. there is a major change in the service delivery model and/or staff which may impact on the delivery of workplace rehabilitation services.
  6. there is any other change that affects, or may affect, the provider’s service quality and procedures.
  7. the provider has entered into voluntary financial administration, becomes insolvent or is the subject of bankruptcy proceedings.
  8. there is any professional misconduct proceedings being taken against the provider or any individuals employed or engaged by the provider.

12.   The Workplace Rehabilitation Provider must accept that the Workers’ Compensation Authority may:

  1. initiate an independent evaluation at any time during the period of the approval which may involve an evaluation of conformance to the Conditions of Approval, and/or
  2. consult with the relevant professional or industry associations in determining what are reasonable expectations regarding performance, and/or
  3. impose additional requirements, and/or
  4. exchange information with other workers’ compensation authorities on provider performance, and/or
  5. cancel approval status if the above conditions are not met.

 

I/We have read, understand and accept that I/we must meet and continue to conform to the Conditions of Approval and give consent for sharing of information in relation to this application and the ongoing approval.

 

I/We understand and are aware that any breach with the terms and conditions of the Conditions of Approval may nullify any application or Instrument of Approval issued by the Workers’ Compensation Authority in the event the application is approved.

 

To be signed by the person/s who is authorised to sign this application on behalf of the organisation seeking approval as a Workplace Rehabilitation Provider.

 

Organisation Name:_____________________________________________________________

Name & Title of authorised signatory:

 

______________________________________________________________________________

Signature of authorised signatory:

 

_________________________________________Date: ___________________

Name & Title of authorised signatory:

 

______________________________________________________________________________

Signature of authorised signatory:

 

_________________________________________Date: ___________________

Appendix 3 - Statement of commitment to the Code of Conduct for Workplace Rehabilitation Providers

 

I/We have read and agree to conform to the Code of Conduct for Workplace Rehabilitation Providers if approved as a Workplace Rehabilitation Provider.

I/We understand and are aware that any breach of the Code of Conduct for Workplace Rehabilitation Providers may nullify any Instrument of Approval issued by the Workers’ Compensation Authority in the event the application is approved.

 

To be signed by the person/s who is authorised to sign this application on behalf of the organisation seeking approval as a Workplace Rehabilitation Provider.

Organisation Name:_____________________________________________________________

Name & Title of authorised signatory:

 

______________________________________________________________________________

Signature of authorised signatory:

 

_________________________________________Date: ___________________

Name & Title of authorised signatory:

 

______________________________________________________________________________

Signature of authorised signatory: 

 

_________________________________________Date: ___________________

 

I, _________________________________________________________________
(please print full name)

holding the position of: _______________________________________________ ,
(please print title)

on behalf of the applicant: _____________________________________________
(please print name of applicant)

1)  certify that the information provided in this application and in support of the application is true and correct. I understand that giving false or misleading information is a serious offence under the Criminal Code

2)  agree to advise Comcare as soon as possible of any changes to the information provided in this application, and

3)  authorise relevant persons to provide to Comcare personal information in relation to this application and for the purposes of enabling Comcare to determine whether the applicant, a relevant principal or employee of the applicant is complying with the Operational Standards for Workplace Rehabilitation Providers (Rehabilitation Program Providers) determined under section 34E of the SRC Act. In particular, I understand that this authorises Comcare to seek confirmation of the qualifications, probity and financial standing of the applicant, relevant principals and any Workplace Rehabilitation Provider engaged or employed and the likely effectiveness, availability and cost of the rehabilitation programs which may be provided by the applicant.

If the applicant is approved as a Workplace Rehabilitation Provider, I:

4)  understand that failure to comply with the Operational Standards for Workplace Rehabilitation Providers (Rehabilitation Program Providers) determined under section 34E of the SRC Act or the Criteria for Approval or Renewal of Workplace Rehabilitation Providers (Rehabilitation Program Providers) determined under section 34D of the SRC Act may result in the revocation of approval under section 34Q of that Act; and

5)  agree to advise Comcare in writing within one month of any changes in Workplace Rehabilitation Providers employed or engaged by the applicant to manage return to work plans under the SRC Act, including evidence of qualifications, experience/supervision arrangements and training

6)  agree to Comcare listing the applicant’s name, service delivery description and contact details on Comcare’s website.

 

Signed:…………………………………..(Applicant)  Date: