Rehabilitation and Return to Work Policy - Concordia College ...

REHABILITATION
and
RETURN TO WORK
POLICY
Approval to
Publish
This policy is approved for publication by the Concordia
Lutheran College Council having considered relevant
legislation dates and/or implementation requirement of
users.
EFFECTIVE
20 May 2012
Next Scheduled
Review Date
All procedures have an automatic review date as specified.
Review dates cannot be greater than 2 years following
implementation date
REVIEW
2 Years
Access and
Availability
All sections of procedure will be visible on the Concordia
Lutheran College intranet and published in staff handbook.
Availability for public access
Yes
Yes
RECOMMENDATION
Head of College
20 / 05 / 2012
APPROVAL
20 / 05 / 2012
Chairman of College Council

Rehabilitation and Return to Work Policy
Contents
Concordia Lutheran College
154 Stephen Street
Toowoomba Q 4350
(07) 4688 2700
Page
OUR PERSPECTIVE ........................................................................................................... 4
POLICY STATEMENT ......................................................................................................... 5
AIMS .................................................................................................................................... 6
SCOPE ................................................................................................................................ 6
DEFINITIONS ...................................................................................................................... 6
COUNCIL ............................................................................................................................ 6
GROUP SALARY CONTINUANCE INSURANCE ........................................................................... 6
INJURY MANAGEMENT .......................................................................................................... 6
HEAD OF COLLEGE .............................................................................................................. 5
PROCEDURE ....................................................................................................................... 6
SCHOOLS (SCHOOL/S) ......................................................................................................... 6
WORKCOVER INSURER ........................................................................................................ 6
WORKPLACE REHABILITATION .............................................................................................. 6
ROLES, RIGHTS AND RESPONSIBILITIES ....................................................................... 7
1. THE INJURED OR ILL EMPLOYEE ................................................................................... 7
2. THE CONCORDIA LUTHERAN COLLEGE ......................................................................... 8
3. THE REHABILITATION AND RETURN TO WORK COORDINATOR (RRTWC) ........................ 8
4. THE ROLE OF THE HEAD OF COLLEGE/ MANAGERS/SUPERVISORS: ................................ 9
5. RIGHTS OF THE HEAD OF COLLEGE .............................................................................. 8
6. RESPONSIBILITIES OF THE HEAD OF COLLEGE ............................................................... 9
LEQ DISTRICT REHABILITATION AND RETURN TO WORK COORDINATOR ........................ 10
7. FELLOW EMPLOYEES ................................................................................................ 10
8. MEDICAL PRACTITIONER/S ........................................................................................ 10
PROCEDURES FOR CLAIMS ........................................................................................... 11
A. FOR WORKCOVER CLAIMS (A WORK RELATED INJURY OR ILLNESS) .............................. 11
B. FOR GROUP SALARY CONTINUANCE INSURANCE CLAIMS (GSCI)................................. 11
DESCRIPTIONS ................................................................................................................ 12
SUITABLE DUTIES PROGRAMS ............................................................................................ 12
SUITABLE DUTIES PLANS ................................................................................................... 12
PROCEDURES FOR WORK RELATED INJURIES OR ILLNESS .................................... 12
PROCEDURES FOR NON-WORK RELATED INJURIES/ILLNESS ................................. 13
PAYMENT OF WAGES DURING REHABILITATION ........................................................ 13
FOR WORK RELATED INJURIES/ILLNESS .............................................................................. 13
FOR NON-WORK RELATED INJURIES/ILLNESS ...................................................................... 13
POLICY EFFECTIVE DATE .............................................................................................. 14

Table of Contents
APPENDIX 1 ...................................................................................................................... 15
LETTER TO INJURED EMPLOYEE ......................................................................................... 15
APPENDIX 2 ...................................................................................................................... 16
AUTHORISATION ................................................................................................................ 16
APPENDIX 3 ...................................................................................................................... 17
LETTER TO MEDICAL PRACTITIONER ................................................................................... 17
APPENDIX 4 ...................................................................................................................... 18
WORK CAPABILITIES CERTIFICATE ...................................................................................... 18
APPENDIX 5 ...................................................................................................................... 19
SUITABLE DUTIES / REHABILITATION PLAN ........................................................................... 19
APPENDIX 6 ...................................................................................................................... 21
RETURN-TO-WORK ADVICE ............................................................................................... 21
APPENDIX 7 ...................................................................................................................... 22
WAGE INFORMATION (WORK RELATED) ............................................................................... 22
APPENDIX 8 ...................................................................................................................... 24
WAGE INFORMATION (NON-WORK RELATED)....................................................................... 24
APPENDIX 9 ...................................................................................................................... 26
REHABILITATION CLOSURE ................................................................................................. 26
APPENDIX 10 .................................................................................................................... 27
WORKER EVALUATION FORM.............................................................................................. 27
APPENDIX 11 .................................................................................................................... 28
CONCORDIA LUTHERAN COLLEGE REHABILITATION PROCEDURES ......................................... 28
APPENDIX 12 .................................................................................................................... 29
CONCORDIA LUTHERAN COLLEGE REHABILITATION PROCEDURE FOR INJURED WORKERS ....... 29

Rehabilitation and Return To Work Policy
OUR PERSPECTIVE
In the Lutheran school the gospel is to ‘inform all programs, relationships and activities’ (LCA
and Its Schools statement). The love of God in Jesus Christ is to govern all that is done and,
in response to this love, people in the school community are directed to their fellow human
beings. When they love others they love Him. Christ’s promise is that whatever is done for
others is done for Him. Informed and transformed by God’s creative, redemptive and
sanctifying love, God’s people are concerned with the total needs of their fellow human
beings.
This means that the Lutheran school will exercise a ministry of care to all in its employ – not
least of all to those who have been away from their work place. The school values the
unique giftedness of each individual and will assist them in returning to work so that they can
be all that they are under God. This may well mean going the extra mile with them, but in so
doing the school will reflect its core values and be seen to be an authentic and credible
caring community.
Work is a gift of God for the good of creation. Work is part of our essence as human beings.
In work God grants His people the privilege of being co-workers with Him in the ongoing work
of creation. A culture of rehabilitation to work affirms the individual so that they can use their
God given gifts in service.
The Lutheran school will gladly fulfil all of its legal responsibilities and it will do this in a spirit
of love and care. Rehabilitation is thus not a burden but a way in which the love of God
constrains those who make decisions in this area.
The Lutheran school can concur with the following words from industry:
With a return to work physical and mental skills aren't lost, and the important work-related
social relationship which can contribute to mental and social well being are maintained
(Simon Doctor, National Safety Council of Australia-Australian Safety, April 2001).
Such a culture demonstrates an appreciation of the contribution which work, as a gracious
gift of God, makes to both the life of the worker and fellow workers. Lutheran schools value
the gifts of those who act as employers and as employees.
Executive Director
Lutheran Education Australia
4

Rehabilitation and Return To Work Policy
POLICY STATEMENT
Concordia Lutheran College recognises that there are substantial benefits to be gained from
rehabilitation principles and practices and is committed to implementing them at this school.
We recognise that the Workers’ Compensation and Rehabilitation Act 2003 and the Workers'
Compensation and Rehabilitation Regulation 2003 provide the legislative support for
workplace rehabilitation activities.
Experience has shown that workplace rehabilitation assists the healing process and helps
restore the worker’s normal function sooner. Workplace rehabilitation includes early
provision of timely and adequate services, including suitable duties programs, and aims to: -
maintain injured or ill workers at work or
ensure the worker’s earliest possible return to work or
maximise the worker’s independent functioning and
provide for durable employment.
Concordia Lutheran College acknowledges that the process of Rehabilitation is a positive
move towards retaining the job skills of employees who have been injured or ill as well as
reflecting the Christian-based caring atmosphere of the School. As such, the Concordia
Lutheran College is committed to the following measures:
Providing a safe and healthy work environment, but in the event of an injury or an illness,
making sure workplace rehabilitation is started as soon as possible in accordance with
medical advice.
Ensuring appropriate suitable duties are made available to injured or ill workers to
facilitate their safe and early return to work. These duties must be consistent with the
current medical certificate and will be time limited.
Respecting the confidential nature of medical and rehabilitation information and ensuring
there will be both verbal and written confidentiality.
Ensuring all workers are aware that, in the event of injury or illness, they will be consulted
to ensure a structured and safe return to work that will not disadvantage them.
Complying with legislative obligations with respect to the standard for rehabilitation.
Adopting a multidisciplinary approach to rehabilitation as required.
Reviewing this policy and procedures at least every three years to ensure it continues to
meet legislative requirements and the needs of all parties.
Our Rehabilitation and Return to Work Coordinator is based at Redlands Campus.
Head of College
Adopted by College Council on 22 August 2012
To be reviewed by 20 May 2014
5

Rehabilitation and Return To Work Policy
AIMS
The aims of the policy are to ensure that:
all employees of Concordia Lutheran College have the right to Workplace Rehabilitation
and that return to work is the normal practice and expectation, even if only in stages
and/or on a part time basis as part of a rehabilitation process, providing suitable assessed
duties can be found.
workplace rehabilitation commences at the time of injury or illness or when treatment
commences, whichever is most practical.
there is early medical assessment and involvement of a rehabilitation provider, as
required, to provide individual rehabilitation and return to work plan outlining suitable or
alternate duties, where necessary, for an early return to work.
there is ongoing contact between the Rehabilitation and Return to Work Coordinator,
employee and where necessary his or her family and offer moral support.
there are adequate resources are allocated towards training and the provision of storage
of confidential files.
SCOPE
Concordia Lutheran College Council is committed to the measures outlined in the
Rehabilitation policy statement and covers all employees of the School.
DEFINITIONS
Council refers to Concordia Lutheran College Council.
Group Salary Continuance Insurance: For members of the insurance plan or Lutheran
Church of Australia Superannuation Fund, income protection insurance for injuries or illness
that are not covered by Workers Compensation.
An Injury: is personal injury arising out of, or in the course of, employment if the employment
is a significant contributing factor to the injury (as per Section 32 of Act).
Injury Management: the process of using Workplace Rehabilitation to bring about an early
and safe return to work.
Head of College: refers to Head of College, Concordia Lutheran College.
Procedure: refers to the scope and purpose of an activity and outlines how it is to be carried
out.
Schools (school/s): refers to all early learning services which are part of the College, all
primary campuses, outdoor education centre, and secondary school.
Workcover Insurer: WorkCover Queensland
Workplace Rehabilitation: is a system of rehabilitation accredited by the Authority that is
initiated or managed by an employer. (as per Section 43 of the Act)
6

Rehabilitation and Return To Work Policy
ROLES, RIGHTS AND RESPONSIBILITIES
1. The Injured or Ill Employee
Injured or ill employees are expected by Concordia Lutheran College to actively participate in
workplace rehabilitation in order to resume their normal duties in the workplace as soon as
practicable following injury or illness. They are required to:
advise the School as soon as possible of any injury or illness that is likely to affect their
work.
obtain appropriate treatment for the injury/illness.
obtain the correct forms and apply for workers’ compensation through WorkCover
Queensland.
request that their treating medical practitioner complete a QCOMP Certificate (for workrelated
injuries or illness) or the Medical Practitioner’s section of AMP insurance form for
Salary Continuance.
advise their treating medical practitioner or rehabilitation advisor that a Workplace
Rehabilitation program is available.
request that their treating medical practitioner complete the Work Capabilities Certificate.
(Appendix 4)
actively participate in workplace rehabilitation.
maintain communication with the Rehabilitation and Return to Work Coordinator about
relevant issues related to their compensation claim and provide regular feedback to
enable an accurate evaluation of any agreed rehabilitation and return to work plan.
All persons employed by Concordia Lutheran College have the following rights with regard to
workplace rehabilitation:
workers’ compensation for work-related injuries accepted by the insurer.
choose their own doctor.
authorise the Rehabilitation and Return to Work Coordinator to contact their doctor for
advice on suitable duties.
confidential, safe keeping of personal medical information.
be provided with suitable duties, if practicable, as part of any rehabilitation program.
be consulted in the development of a suitable duties program.
union representation if so desired.
ask for a Q-COMP review of certain insurer’s decisions with which they do not agree
have access to an impartial grievance mechanism, which is accessed in the first instance
by raising the grievance with the Rehabilitation and Return to Work Coordinator for
resolution or escalation.
7

Rehabilitation and Return To Work Policy
2. Concordia Lutheran College
Concordia Lutheran College is committed to provide a workplace based rehabilitation and
return to work program for all staff. To meet this objective the Concordia Lutheran College
recognises the need to ensure that:
currency of the workplace rehabilitation policy & procedures is maintained
all reasonable steps are taken to assist or provide the injured or ill employee with suitable
duties for the period for which the employee is entitled to compensation.
rehabilitation is provided of a suitable standard as prescribed under the Act and
regulations
written evidence to WorkCover is provided if an employer considers it is not practicable to
provide the worker with suitable duties.
3. The Rehabilitation and Return to Work Coordinator (RRTWC)
The position of Rehabilitation and Return to Work Coordinator (RRTWC) has been
established as required by the Workers’ Compensation and Rehabilitation Act 2003 (s226).
The RRTWC must be based in Queensland and may be employed under a contract either as
an employee or a contractor. The role does not need to be a full time position and may be
incorporated within an existing employee’s duties. RRTWC’s must successfully complete an
approved training course (provided by QComp Approved Training Organisations) to become
registered and receive a letter issued by Q-COMP indicating the registration number.
Completion of an updated course is required every three years to maintain registration. The
RRTWC works with the injured worker and the treating doctor to establish appropriate
rehabilitation strategies. This may be in consultation with the workers’ compensation insurer
and/or a rehabilitation provider if assistance is required.
The role of the Rehabilitation and Return to Work Coordinator is to assist the
Concordia Lutheran College to:
Ensure an efficient system exists for immediate reporting of injuries to enable early worker
contact regarding rehabilitation, to comply with employer’s duty to report injury to the insurer
and to ensure confidentiality of information received.
Develop, coordinate and monitor workplace rehabilitation strategies for injured workers,
including developing suitable duties programs in consultation with injured workers
undertaking rehabilitation.
Educate all workers about the workplace rehabilitation policy and procedures and what to
expect when an injury occurs. To educate managers, supervisors and workers regarding
their role and responsibilities for rehabilitation. To ensure education is part of the new staff
induction process.
Where possible and on behalf of the employer, to ensure rehabilitation for a worker is
coordinated with and understood by line managers, supervisors and co-workers.
Promote the Concordia Lutheran College’s workplace rehabilitation program internally to
maintain staff’s commitment, and externally, to local doctors so as to build a good working
relationship and gain their trust and assistance.
Keep a file for each worker undertaking rehabilitation and to ensure confidentiality of both
verbal and written information.
8

Rehabilitation and Return To Work Policy
Keep accurate and objective case notes of all communications, actions and decisions, and
reasons for actions and decisions and to sign and date each notation.
Provide injured workers with the opportunity to give feedback on the rehabilitation system
and to document this feedback.
When an employee is injured or becomes ill, the Rehabilitation and Return to Work
Coordinator will:
• Initiate and maintain contact with the injured employee as soon as possible after the injury
or illness has occurred.
• Ensure that the injured or ill employee has access to appropriate information and
resources.
4. The Role of the Head of College/Managers/Supervisors:
The Head of College has a central role in ensuring the success of any rehabilitation program:
To Actively assist the Rehabilitation and Return to Work Coordinator in identifying and
coordinating suitable duties.
To Adjust workplace procedures and rosters to enable successful implementation of the
suitable duties plan.
To Monitor the injured worker’s progress in relation to suitable duties.
To Educate employees and develop prevention programs.
To Work towards the creation of an environment conducive to Workplace Rehabilitation.
To Advise fellow workers of the injured or ill person's capabilities and negotiate any
workplace adjustments in advance of the return to work.
To generally offer support and encouragement to any injured worker.
5. Rights of the Head of College
The Head of College has the right:
To be kept informed of medical status and Workplace Rehabilitation process.
To actively participate in the development of any suitable duties and/or return to work
plan.
To monitor and review the return to work of an injured employee.
6. Responsibilities of the Head of College
The Head of College has the following responsibilities in regard to Workplace Rehabilitation:
To appoint a RRTWC.
To appoint a Rehabilitation Provider (as required) in consultation with the treating medical
practitioner and Workcover case manager.
To participate in and be supportive of the rehabilitation plan and return to work process
and communicate this to staff as appropriate.
To provide appropriate work at the same or equal level whenever possible, where an
employee cannot return to pre-injury/illness employment.
To assist employees, with relocation or training whenever possible, to identify suitable
duties within the School.
To ensure assistance is given to complete forms and to ensure employees are aware of
their rights and responsibilities.
To ensure the RRTWC is notified regarding injury/illness, rights and return to work
potential.
To identify and implement strategies to prevent similar injuries to other employees.
9

Rehabilitation and Return To Work Policy
7. The role of the LEQ District Rehabilitation and Return to Work Coordinator
Support the consideration and execution of claims process for WorkCover or AMP.
Promote a culture of rehabilitation in Lutheran Schools through policies and resources.
Support and assist Schools in the rehabilitation process.
Facilitate issues between WorkCover, School and employee or AMP, School and
employee when required to do so.
8 Fellow Employees
Fellow employees in the workplace are encouraged to support and enrich a rehabilitative
environment in the workplace.
9. Medical Practitioner/s
The treating medical practitioner accepts responsibility for the overall management of the
injured or ill persons and may delegate the routine rehabilitation management to the RRTWC
and/or rehabilitation provider.
The injured or ill employee has the right to consult a Medical Practitioner of their own choice
for treatment.
10

Rehabilitation and Return To Work Policy
PROCEDURES FOR CLAIMS
A. For WorkCover Claims (A work related injury or illness)
1. Complete a Workplace Health and Safety Incident Record/Report;
2. A WorkCover claim should be lodged for all work related injuries. This is done by
completing a WorkCover Application for Compensation form and WorkCover Employer
Report. The Workers’ Compensation and Rehabilitation Act 2003 states that an injured
worker has 6 months from the date of injury to lodge a claim (however, if the application is
lodged more than 20 business days after the injury then the insurer’s liability to pay
compensation is limited to a period starting no earlier than 20 business days before the
application is lodged).
3. Worker’s Compensation Medical Certificate to be obtained by the injured or ill employee
from their treating Medical Practitioner and presented to the employer;
4. Where applicable a signed authorisation from the injured or ill employee, for the
Rehabilitation and Return to Work Coordinator to enable direct liaison with the treating
Medical practitioner/s. (Attachment )
5. In consultation with the Medical Practitioner/s, the Rehabilitation Provider for the injured
or ill employee, therapists and physiotherapists, begin work on the rehabilitation plan.
6. Establish and maintain a good working relationship with the claims and rehabilitation staff
at WorkCover.
7. Maintain a good line of communication between all parties involved and ensure that all
records are kept up to date and confidential.
B. For Group Salary Continuance Insurance Claims (GSCI)
1. Request the Salary Continuance Insurance Claim Form from the Rehabilitation and
Return to Work Coordinator.
2. Complete the injured or ill employee's individual form and request that the Medical
Practitioner completes the Medical Practitioner’s claim form.
3. Lodge completed claim forms with the RRWTC to forward copy to AMP.
4. Where applicable a signed authorisation from the injured or ill employee, for the
Rehabilitation and Return to Work Coordinator to liaise directly with the treating Medical
practitioner/s to assist with the rehabilitation plan.
5. A 90 day waiting period applies.
6. If the claim is rejected, the injured or ill employee may appeal and request a review.
11

Rehabilitation and Return To Work Policy
DESCRIPTIONS
Suitable Duties Programs
These specially selected duties at the workplace are a means of offering a monitored and
graduated return to normal duties. They are:
matched to the capabilities of the worker.
time limited and regularly upgraded according to his/her level of recovery and treating
medical doctor advice.
The following issues must be considered when choosing suitable duties:
the worker’s pre-injury duties, age, education, skills and work experience and nature of
the incapacity.
the restrictions and limitations specified by the treating doctor, who must also document
approval for all plans and amendments; and
regard for the objectives of the worker’s rehabilitation plan and be meaningful.
Suitable Duties Plans may be either
Fully Funded by the insurer/WorkCover; or
Partially Funded by both the employer and the insurer or
Medical Expenses Only (insurer reimburses medical/treatment costs and employer pays
wages).
PROCEDURES FOR WORK RELATED INJURIES OR ILLNESS
• Employees must obtain first aid, nursing or medical assistance in the first instance as
necessary.
• All injuries must be documented and reported to the Head of College/Workplace Health
and Safety Officer/Rehabilitation and Return to Work Coordinator within 24 hours of
injury/illness occurring.
• The Workplace Health and Safety Officer shall investigate injury/illness occurrence and
initiate further preventative action where required.
• Injured employee shall undertake necessary treatment and Workplace Rehabilitation.
• Where injury/illness results in the employee having time off work:
(a) The RRTWC shall contact the injured employee to:
i ascertain degree of injury/illness;
ii reassure employee of rights and responsibilities under this policy;
iii if appropriate, instigate the steps as outlined in the RRTWC’s role.
(b) The RRTWC shall liaise with the injured employee, Treating Medical Practitioner,
Rehabilitation Providers, the Head of College, the Council and WorkCover to establish
rehabilitation goals.
(c) The RRTWC shall ensure documentation of the rehabilitation plan and obtain
signatures of all involved parties.
12

Rehabilitation and Return To Work Policy
PROCEDURES FOR NON-WORK RELATED INJURIES/ILLNESS
The injured/ill employee will contact the Head of College to advise of the nature and
consequences of the injury/illness.
Necessary sick leave shall be applied for.
The injured employee shall undertake necessary treatment and rehabilitation. Workplace
return to work programs for non-work related injuries/illness are voluntary but are
expected.
Where injury/illness results in the employee having time off from work:
(a) The Head of College shall contact RRTWC with injury/illness details.
(b) RRTWC will ensure that contact is made with the injured employee as soon as
practicable in order to:
i reassure employee of rights and responsibilities.
ii inform employee of RRTWC role and that all possible assistance shall be given.
RRTWC will liaise with injured employee, the treating Medical Practitioner, rehabilitation
providers, the Head of College and the Council and RSA (where relevant) to develop
rehabilitation goals and a return to work plan.
RRTWC shall ensure documentation of rehabilitation plan and signatures of all involved
parties.
RRTWC shall monitor the return to work program and ensure the injury/illness is not
aggravated.
PAYMENT OF WAGES DURING REHABILITATION
The following are guidelines to be used when negotiating payment for injured employees on
a Return to Work Program:
For Work Related Injuries/Illness
(a) On the advice of the treating Medical Practitioner, if an injured employee is
assessed fit to return to work on a graduated return to work program, the School shall
pay normal pay to that person (including allowances where applicable) for the actual
hours worked. WorkCover payments will compensate for hours not worked to the
maximum allowable for that employee.
(b)
If an injured worker is assessed as not fit for work then normal WorkCover
payments will apply.
For Non-Work Related Injuries/Illness
(a) On the advice of a treating medical practitioner, if an injured/illness worker is assessed
as fit to return on a graduated return to work program the School will pay for the actual
hours worked. Sick leave or partial GSCI payment shall apply (where available) for
hours not worked to the maximum allowable for that employee.
(b)
If an injured worker is assessed as not fit for duty then normal Sick Leave shall
apply or GSCI payments (where available) according to the agreed policy.
13

Rehabilitation and Return To Work Policy
GRIEVANCE PROCEDURE
If an injured worker is unhappy with a decision made at the workplace regarding their
rehabilitation, they can raise the matter with the RRTWC. If the matter is unresolved they
can request the manager review the decision. If they remain unhappy with the decision
following internal review they may request that the WorkCover Queensland case manager
becomes involved to resolve the dispute.
If either an injured worker or the Concordia Lutheran College is unhappy with a decision
made by WorkCover Queensland, the decision may be reviewable with Q-COMP. Strict time
frames apply.
POLICY EFFECTIVE DATE
This policy guideline came into effect on ________________________and will be reviewed
at least every three years by Concordia Lutheran College Council.
Signed
Chairman
Dated
for and on behalf of the Concordia Lutheran College Council.
14

Appendix 1
APPENDIX 1
Letter To Injured Employee
Dear _____________________________
On behalf of the Concordia Lutheran College Council, please accept our best wishes for
your recovery following your recent injury/illness/condition. As a valued member of this
School you are missed by your friends and colleagues. We will remember you in our
morning prayers and pray that God will grant you a speedy recovery and give you His
strength to help you through this difficult time.
As you are aware Concordia Lutheran College Council is committed to Workplace
Rehabilitation and return to work and all necessary provision will be available to assist
your recovery. We will contact you again shortly to discuss how we can best assist you.
Yours sincerely
Rehabilitation and Return to Work Coordinator
15

Appendix 2
APPENDIX 2
Authorisation
I ____________________ hereby give consent for the following people to discuss with my
employers’ Rehabilitation and Return to Work Coordinator ___________________,
specific injury/illness information to assist with my rehabilitation plan and safe return to
work:
1. Name:
Address:
Phone No:
Fax No:
Email:
2. Name:
Address:
Phone No:
Fax No:
Email:
I understand this consent is required to assist with my rehabilitation and return to work and
that all information obtained is treated in confidence.
Signed:
Employee
Name:
Dated
16

Appendix 3
APPENDIX 3
Letter To Medical Practitioner
Dear Medical Practitioner: _________________________________________
____________________ is employed by Concordia Lutheran College. Our policy is to
encourage early return of our employees to full employment as soon as practicable
following an injury or illness. Where possible they are returned to their usual work or some
suitable work within their capacity.
We require your help in formulating a Workplace Rehabilitation program to ensure that
_____________________________ who is employed as _________________________
can return to their usual work or is provided with appropriate duties if necessary.
Any information you could provide on the attached checklist would be most useful.
Additional information about the job can be provided for you if required.
I have attached a copy of the Authorisation to contact you, given to us by
____________________________________________________ .
We look forward to your contribution to our rehabilitation team effort.
Yours sincerely
Rehabilitation and Return to Work Coordinator
17

Appendix 4
APPENDIX 4
Work Capabilities Certificate
I have examined ___________________________ and consider that he/she has the
following condition________________________________________________________
1. The employee is fit to resume normal duties YES / NO
2. The employee will be unfit for ________days up to and including
___________________________
3. The employee is partially fit and capable of performing selected duties with the
following limitations (Please complete appropriate section):
Reduced work hours: _______hours/week ________days/week
Visual tasks only.______________________
A job which does not involve manual handling
Lifting weights of not more than ________kg
Work not involving the right/left - hand/arm/shoulder/leg
Light bench work only
Sitting position only
No ladders or on unguarded heights
Other: (Please specify)_____________________________________________
4. The employee will be reassessed on _____________________________________
The employee has been referred to:
(a)
(b)
(c)
Specialist: ______________________ Specialty: _____________________
Physiotherapist: ________________________________________________
Other: _______________________________________________________
5. Signed: ____________________________ Date: ________________________
Medical Practitioner Stamp:
18

Appendix 5
APPENDIX 5
Suitable Duties / Rehabilitation Plan
Name of Worker: Date: / /
Name of Supervisor/s:
Department:
Department:
Name of Rehabilitation
Provider:
Overall Goal
(ie Return to normal
duties):
Objectives for the
Period
of this Plan:
RETURN TO WORK JOB DETAILS (TO MEET THE STATED OBJECTIVES)
Week 1
Days/Times:
Duties:
Week commencing: ______ / ______ / ______
Week 2
Days/Times:
Duties:
Week commencing: ______ / ______ / ______
Training Required:
Remuneration Details:
Anticipated Period of Return to
Work Program: / / to / /
Anticipated Costs Of Program
(Details) $
(A REHABILITATION PROGRAM MUST BE IMPLEMENTED
IN ACCORDANCE WITH PART “E” OF THE MEDICAL CERTIFICATE (for work-related
injuries/illnesses)
19

Appendix 5
Signature of treating
Medical Practitioner: Date: / /
Signature of Supervisor: Date: / /
Signature of WRRC: Date: / /
Signature of Worker: Date: / /
Copy given to:
WorkCover AMP Supervisor RRTWC’s File Medical Practitioner
Date of Review: Date: / /
Comment:
Follow up (next step/s)
20

Appendix 6
APPENDIX 6
Return-To-Work Advice
To:
WorkCover/ Rehabilitation Counsellor/Workplace Injury/Illness
Management Team.
Company Name: __________________________________________________
Rehabilitation and Return to Work Coordinator Name: _____________________
Contact Tel.& Fax: _________________________________________________
WorkCover Policy No/ AMP Policy No.:_________________________________
Date of Request: ______ / _______ / ______
Injured Employee’s Full Name: __________________________________________
Claim No: _____________________________
Date of Birth: ____ / ____ / ___
Please (Tick)
Suitable Duties Plan to be used:
Suitable Duties
Plan 1
* PARTIALLY FUNDED by
WorkCover compensation
* Medical Certificate:
Partial Incapacity
Suitable Duties
Plan 2
* FULLY FUNDED by
WorkCover compensation
* Medical Certificate:
Total Incapacity
Suitable Duties
Plan 3
* EMPLOYER FUNDED
* Medical Certificate:
Medical Expenses Only
On-going medical treatment e.g. Physiotherapy etc. YES NO
Name of Approving Medical Practitioner: _______________________________________
Contact Telephone: ________________________
Proposed Date of Commencement: ___ / ___ / ___
Fax: ________________________
Length of Plan: _______________
N.B.
A COPY OF THE FOLLOWING MUST BE ATTACHED
1. Current Medical Certificate
2. Suitable Duties Plan
21

Appendix 7
APPENDIX 7
Wage Information (Work Related)
SUITABLE DUTIES PLAN 1
PARTIALLY FUNDED by WorkCover
MEDICAL CERTIFICATE: Partial Incapacity
To: WorkCover Claims Officer/Workplace Injury/Illness Management Team.
Company Name:______________________________________________________
Rehabilitation and Return to Work Coordinator Name:_________________________
Contact Telephone & Fax:________________________________________________
WorkCover Policy No: ___________________ Date of Request: ____ / _____ / _____
Injured Worker’s Full Name: ______________________________________________
Claim Number:
____________________
Wages Period From _____ / _____ / _____ to _____ / _____ / _____
ONE WEEK
For the week commencing _____ / _____ / _____
Normal Daily Roster
Actual Hours
Worked
Monday ____________________ ___________________
Tuesday ____________________ ___________________
Wednesday ____________________ ___________________
Thursday ____________________ ___________________
Friday ____________________ ___________________
Saturday ____________________ ___________________
Sunday ____________________ ___________________
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Appendix 7
Total hours paid for: __________________
Gross wages paid for this period $_____________
Award Rate $________________
Gross normal weekly earnings
$_____________.
Weekly Hours specified in Award _____________.
Please comment on how the Worker is progressing:
These details are essential for WorkCover to calculate correct payment.
N.B. A COPY OF THE FOLLOWING MUST BE ATTACHED.
1. Current Medical Certificate
2. Rehabilitation Plan
23

Appendix 8
APPENDIX 8
Wage Information (Non-Work Related)
SUITABLE DUTIES PLAN 1
PARTIALLY FUNDED by AMP
MEDICAL CERTIFICATE: Partial Incapacity
To:
AMP Claims Officer/Workplace Injury/Illness Management Team.
Company Name: ___________________________________________________
Rehabilitation and Return to Work Coordinator Name: _____________________
Contact Telephone & Fax: ___________________________________________
RSA Policy No: ____________________________ Date of Request: ___ / ___ / ___
Injured Workers Full Name: ____________________________________________
Claim Number:______________________________________________________
Wages Period From _____ / _____ / _____ to _____ / _____ / _____
ONE WEEK For the week commencing _____ / _____ / _____
Normal Daily Roster
Actual Hours
Worked
Monday ____________________ ___________________
Tuesday ____________________ ___________________
Wednesday ____________________ ___________________
Thursday ____________________ ___________________
Friday ____________________ ___________________
Saturday ____________________ ___________________
Sunday ____________________ ___________________
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Appendix 8
Total hours paid for: _____________________________
Gross wages paid for this period $_____________
Award Rate $________________
Gross normal weekly earnings
$_____________.
Weekly Hours specified in Award _____________.
Please comment on how the Worker is progressing:
These details are essential for RSA to calculate correct payment.
N.B. A COPY OF THE FOLLOWING MUST BE ATTACHED.
1. Current Medical Certificate
2. Rehabilitation Plan
25

Appendix 9
APPENDIX 9
Rehabilitation Closure
Employee’s Name
Date of Birth
Vocation (eg
Teacher, Cleaner etc)
Date of
Injury/Illness
Bodily Location
/ /
Claim No
Postcode
Industry Type
Injury/Illness
Type (eg Broken
Arm, cut etc)
Injury/Illness
Mechanism (eg
slip, fall etc)
Return to Work Outcome
1. Back at work:
Return to work date: _____ / _____ / _____
Outcome achieved:
Employer Duties Hours
Same Same Same
New Modified Reduced
New
Date the above goal was achieved: _____ / _____ / _____
2. Employee is totally and permanently incapacitated for work
3. Employee is partially incapacitated but unable to place in suitable employment
Case Deferred to: _____ / _____ / _____
Voluntary Retirement
Redundancy
Employee withdrew from programme or declined to work
4. Additional Comments:
Date of Case Closure: _____ / _____ / _____
Cost of Claim: $______________
Signed Rehabilitation and Return to Work Coordinator: _________________________
26

Appendix 10
APPENDIX 10
Worker Evaluation Form
To be given to a worker 1 month after a claim is finalised.
To ensure that our Workplace Rehabilitation Policy & Procedures continue to meet our
workers needs, please answer the following questions.
1. How satisfied were you with the Insurers Case Manager
Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied
Why:___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. How satisfied were you with your Rehabilitation and Return to Work Coordinator
Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied
Why:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. How satisfied are you with the outcome of your rehabilitation
Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied
Why:___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. What would you like to see changed in our rehabilitation program
Signed: _______________________________________________________
Print Name_____________________________________________________
Date: ______ / ______ / ______
27

APPENDIX 11
Appendix 11
Concordia Lutheran College Rehabilitation Procedures
Preferred Doctor arrangements
• First aid officer
• Transportation as required
Division of Workplace Health and
Safety Notification
Injury notification process
facilitating appropriate injured
worker’s first aid
contact with treating medical officer
Application for compensation
• Authorisation form
• Letter of introduction to the
doctor
initial paperwork
variable
depending
upon
circumstances
early worker contact and
intervention
• Worker involvement in
development
• Coordinate treatment
• Stakeholder communication
• Identify Suitable Duties
• Identify need for Rehabilitation
Service Provider
• Develop and monitor Suitable
Duties Plan
• Create a Suitable Duties Plan
in accordance with the Medical
Certificate
• Insurer liaison
• Other rehabilitation initiatives
goal directed rehabilitation plan
ongoing coordinating and monitoring
rehabilitation plan including case
notes and other paperwork
obtain worker feedback
Ongoing education and
promotion about rehabilitation in
the workplace
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Concordia Lutheran College

APPENDIX 12
Appendix 12
Concordia Lutheran College Rehabilitation Procedure for Injured Workers
Get the appropriate treatment:
• First aid officer
• Doctor
• Transportation as required
Notify workplace that you
have had an injury and
seek treatment
Attend the doctor (dentist if
required)
To claim workers compensation – you
need a Workers Compensation Medical
Certificate from a doctor
Complete:
• Application for compensation
• Authorisation form
• Tax Declaration
(if time off work)
Obtain:
• Introductory letter to doctor
• Work capabilities checklist
(these are for your doctor)
Hand the Certificate to the
Rehabilitation and Return to Work
Coordinator and complete
paperwork
Stay in contact with your Rehabilitation
and Return to Work Coordinator - keep
them informed about your progress
order
depends
upon
circumstance
You are required to:
• Attend rehabilitation
appointments (e.g.
physiotherapy). Where
possible outside of scheduled
work hours
• Participate in development of
suitable duties plans
• Provide new certificates or
forms for the workplace given
to you by your doctor
• Keep your Rehabilitation and
Return to Work Coordinator
informed about your progress
• Keep your manager up to
date with plans for your
duties and hours
Participate in your rehabilitation and
return to work process
Attend for regular review with your
doctor or other specialists on the dates
required
When your rehabilitation is finished
provide feedback to the Rehabilitation and
Return to Work Coordinator about how
you think it went
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Concordia Lutheran College