Obligations and Rights in Workers Compensation Case Conferences

When an employee has an ongoing workers compensation matter and has been or is likely to be off work for an extended period, the employer’s insurer or the workplace rehabilitation provider is likely to request a worker’s compensation case conference.

A worker’s compensation case conference is a forum where there are at least three attendees. Two of the attendees must be the employee and the employee’s nominated treating doctor. The other attendees may include other stakeholders such as the employer, their insurer and/or the workplace rehabilitation provider with the aim of:
• Setting goals;
• Working through issues and potential barriers facing the employee;
• Ensuring all the stakeholder’s roles and responsibilities are understood;
• Agreeing on time-frames for recovery and return to work plans;
• Updating all the stakeholders on the employee’s current health status.

Generally, the case conference is requested by the insurer or the workplace rehabilitation provider. However, the request may come from any stakeholder. Case conferences can be requested at any time during a work injury claim.

The insurer’s obligations include:
• Advise the employee of the insurer’s intention to seek a case conference and their reasons for doing so;
• Provide a statement of purpose and an agenda for the case conference to all the stakeholders;
• Schedule a case conference at a time that is separate from the employee’s medical consultation, unless otherwise agreed by the employee and their nominated treating doctor.

No. The case conference can be conducted by telephone if it is not possible to have all stakeholders present in the same place at the one time.

It is usual for the employee to attend a medical consultation with their nominated treating doctor prior to the case conference in order for the nominated treating doctor to provide the stakeholders with a current progress medical certificate. The medical consultation is separate from the case conference.

An employee’s medical review with their nominated treating doctor is private and confidential. The employee and their treating doctor should not be pressured into having another person present in the consultation. The employee should make their views clear to their treating doctor.

Any confidential information that is not work related and is disclosed to a treating doctor, cannot be disclosed to the employer, insurer or their representatives.

A worker’s compensation medical certificate will provide sufficient information regarding an employee’s injuries and capacity to return to work. If the information in the certificate is not sufficient, the insurer or their representative can request further information from the treating doctor.

A well organised case conference will:
• Define the issues to be discussed in an agenda;
• Encourage active participation and collaboration of all parties present;
• Discuss realistic strategies to assist the worker returning to work;
• Set time-frames to monitor and review the worker’s recovery and return to work.

A case conference cannot take place without the consent of the employee and there is no obligation on the employee to consent. However, refusal should not be considered unless there are good reasons for doing so or it may appear that the employee is being obstructive.

An employee may choose to refuse to attend a case conference where they believe the insurer or their rehabilitation provider may intend to place pressure on the employee to return to work before they are fit and capable, or attempt to influence the employee’s treating doctor to change the workers compensation medical certificate to enable the worker to return to work.

The employee should have a clear discussion around their capacity and fitness for work with their nominated treating doctor prior to the case conference.