Rehabilitation and return to work guidelines for insurers

The guidelines were developed in response to the 2021 Safe Work Australia National Return to Work Survey results, declining scheme return to work data performance (PDF, 0.49 MB), and scheme intelligence gathered through complaints management and claims and rehabilitation compliance audits.

The guidelines have been informed by extensive consultation with all scheme stakeholders, including insurers, and employer, worker, legal and allied health representatives.

While the new guidelines are targeted at insurers, they also establish insurer, employer and worker responsibilities for RRTW planning, how these interact, and why it’s important to work together to achieve positive outcomes for an injured worker.

Employers play a key role in return to work planning, and an employer’s attitude towards a returning worker can have a critical influence on return to work outcomes.

A worker’s tailored RRTW plan, which is coordinated by an insurer, is an important tool for an employer to influence return to work outcomes and to work collaboratively with a worker, their insurer, and a worker’s treating health providers towards a shared goal.

If possible, employers should offer alternative work duties to support recovery at work. The suitable duties program an employer develops for an injured worker details how to do this and is a key component of a worker’s RRTW plan.

By supporting an injured worker to return to work quickly and safely, employers will improve return to work outcomes for a worker, as well as improve productivity and reduce costs for their business.

Are there any injury/claim types that do not require an RRTW plan?

Every injured worker has the right to a RRTW plan. The level of detail required will depend on the nature of the injury.

For certain injury/claim types, a RRTW plan may involve a file note of a conversation or email to the worker with details of current medical treatment, suitable duties arrangements and any future reviews and next steps. This may include for:

• medical expenses only claims, including for psychological injuries with medical expenses only
• claims that are finalised before they are accepted
• claims that have been closed for administrative purposes with a full medical clearance
• retired injured workers
• latent onset terminal injuries
• injured workers with a serious personal injury as defined the by the Act
• industrial deafness claims
• claims ceased under Section 144a and 144b of the WCR Act, with a written reason for decision
• claims that are re-opened for one doctor consultation only (e.g., removal of stitches)
• injured workers hospitalised for their injury.

Does the 10 day development timeframe risk RRTW planning becoming a 'tick and flick' exercise?

No. A RRTW plan is a living document to be updated as a worker’s recovery progresses. While a plan must be in place within 10 business days of accepting a claim, this plan is to be reviewed and updated as new information becomes available.

Does a worker need a RRTW plan if they have a psychological or physical injury, and their treating doctor has stated they are not fit to participate in RRTW planning within 10 days of the claim being accepted?

Yes, or where this is not possible, an insurer may keep written file notes of the progress, reasons for the delay, and scheduled date for developing the RRTW plan.

Can an insurer develop its own RRTW plan template?

Yes. It is recommended to adopt the template included in the RRTW plan guideline – for insurers (PDF, 1.65 MB), or something similar. The information and level of detail included in a RRTW plan will vary for each worker and will depend on the complexity of the worker’s injury and their individual level of capacity and rehabilitation needs.

At a minimum, an insurer’s RRTW plan template must:

• be written clearly to support worker understanding
• outline the rehabilitation objectives for a worker and the steps required to achieve the objectives
• consider five fundamental areas:

1. Roles, responsibilities and actions.
2. Steps and timeframes.
3. Injury details and treatment plan.
4. Goals, capabilities and restrictions.
5. Work duties and workplace supports.

Is it necessary to include claim and stakeholder details in a RRTW plan?

Yes. A RRTW plan serves as a communication tool for a worker. Including this information ensures a worker has all relevant details in one place.

Workers’ Compensation Regulatory Services (WCRS) performed a targeted audit of all Queensland workers’ compensation insurers focussed on RRTW plans, between 1 March and 13 September 2024.

We conducted the audit to:

• assess how well Queensland workers’ compensation insurers were meeting their obligations in relation to RRTW plans
• identify areas of better practice and opportunities for improvement
• assist in evaluating and reviewing the Rehabilitation and return to work guidelines for insurers to ensure they are effective in positively impacting worker experience and rehabilitation and return to work outcomes, remain evidence-based and provide practical guidance for insurers.

Key results

The audit revealed opportunities to improve. The audit identified that across all files audited, five out of 29 audits met minimum requirements for RRTW plans, which were:

• The insurer developed the RRTW plan in consultation with the worker and the worker’s employer and treating medical provider.
• The RRTW plan included the objective/s and steps to reach the objective/s.
• The insurer maintained the RRTW plan.
• The insurer shared a copy of the worker’s RRTW plan with the worker and the worker’s employer and treating medical provider.

Across all claims audited, 24 out of 29 audits did not meet minimum requirements.

Read the full report (PDF, 2.48 MB) detailing audit findings and WCRS’ response to ensure the scheme is supporting all scheme stakeholders.

Note: The audit did not audit to the standard of the new laws made by the Workers’ Compensation and Rehabilitation and Other Legislation Amendment Act 2024 that commenced on 23 August 2024. These new laws require an insurer to have a written RRTW plan in place within 10 business days of a claim being accepted.

Next steps

Insurers are implementing the findings arising from their own individual audit reports. Actions being taken to improve outcomes include insurers:

• reviewing their systems and processes and ensure they are complying with legislative requirements and the rehabilitation and return to work guidelines for insurers
• looking for ways to implement remediation plans to continuously improve, monitor and review quality assurance, and employ a person-centred approach to the rehabilitation and return to work journey
• consulting with workers to identify opportunities to improve their approach to rehabilitation and return to work planning.

WCRS is continuing to monitor and report on performance relating to RRTW plans, including monitoring improvement action plans required as a result of this audit.