Comprehensive Clinical Reports
WorkCover Queensland understands the importance of your time and expertise. We are committed to providing more efficient and cost effective methods for specialists to provide information to us to assist with developing rehabilitation and return to work plans.
WorkCover may request a Comprehensive Clinical Report (CCR) from treating specialists on claims to ensure detailed information is received upfront. This will improve our working relationship with specialists and enable earlier decision making.
Earlier reporting and decision making means injured workers can access timely treatment which assists with an earlier return to work.
A CCR will also reduce the administrative burden placed on specialists, by removing the need for ongoing work capacity certificate. Work capacity certificates will only be required up to the point that the CCR is received.
When to submit a CCR
The below two options do not require our pre-approval to submit the report on an accepted open claim:
- After initial consult and any imaging has been completed (only if the full treatment plan is known and surgery is not pending)
- Post-surgery, if this has not already been covered in a previous CCR.
When not to submit a CCR
A report is not required, and may not be paid for if:
- Full treatment plan is not known
- Simple injury with no further review by the specialist
- At claim closure
- If a claim is denied or not yet accepted
- When diagnosis is not known due to pending pathology results etc.
- If the treatment plan changes dramatically in direction, a full report is not required, only a progress / short report with the updated changes. Pre-approval is not required for this progress report if there is a dramatic change in direction. It can be billed under 100806 on the table of costs.
Completing the CCR request
- We may request the report as part of the claims process. Alternatively, you can ask us for pre-approval to complete the report
- We may not approve the completion of the CCR if the claim has been rejected, ceased or finalised through permanent impairment
- Once the report is completed, there is no need for a work capacity certificate
- A CCR should be completed and provided to us no later than 20 business days from the initial consultation with the patient
- Where surgery is requested after the initial consultation, the surgery request form should still be used, with the CCR to be completed no later than 10 business days post-surgery
- If the report is received within these timeframes, WorkCover may be charged under item code 100150
- If the report is received outside of these timeframes, WorkCover may be charged under item code 100151.
Areas to be addressed within the CCR
Please address the following in your report:
- History of event reported as the mechanism of injury and is it consistent with presentation?
- Results of clinical examination and diagnosis—include what is pre-existing, what is work related, and copies of diagnostic imaging reports
- If post-operative, what surgical interventions were undertaken and what were the relevant operative findings
- Treatment plan and timeframes, including medications, referrals for further scans or to other providers/services
- Relevant past history
- Likely fitness for pre-injury duties and return to work time frames
- Are suitable duties able to be performed? If so what are the restrictions and timeframes for upgrades
- Other factors that may be impacting on recovery
- Is the injury an aggravation of a pre-existing condition? If so indicate what treatment is for the work related component, and at what point ongoing treatment will be to treat the pre-existing condition
- Based on your diagnosis has the work related injury/aggravation ceased? If not, when do you expect the work-related injury/ aggravation is likely to resolve?
- Do you consider an independent medical examination is required for opinion on causation and/or ongoing management? If yes, please advise if you have specific questions you would like addressed with the examiner
- Any additional comments to assist in the return to work focus/recovery of the injured worker.
- Last updated
- 30 June 2016
WorkCover Queensland accident insurance policy renewal
Pay your premium in full or set up an interest free payment plan quickly and easily online before the 30 September deadline.