Unit of competency details

Unit descriptor 

This unit describes the performance outcomes, skills and knowledge required to process and analyse both workers compensation and sick leave claims. It also covers the establishment of rehabilitation needs and return to work programs, and their monitoring, ongoing review and evaluation.

No licensing, legislative, regulatory or certification requirements apply to this unit at the time of endorsement.

Application of the unit 

This unit applies to human resources managers or specialists who manage claims and ensure that the organisation provides appropriate support for the worker.

Note that the unit does not in any way address the process of curing the worker of their injury or illness as this is the task of the health professional. Instead the unit focuses on the process of dealing with claims and ensuring that the organisation supports the worker through return to work programs.

In large organisations this work may be a full time role for some people, in smaller organisations it would typically be a part of a broader role with a human resources focus.

Prerequisite units 

Employability skills 

This unit contains employability skills.

Elements describe the essential outcomes of a unit of competency.

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the required skills and knowledge section and the range statement. Assessment of performance is to be consistent with the evidence guide.

ELEMENT 

PERFORMANCE CRITERIA 

1. Analyse claims

1.1. Ensure that the organisation has and maintains a current Workers' Compensation insurance policy (or equivalent) as required by the applicable legislation

1.2. Process claims  in accordance with organisational policies, and legal and insurance requirements

1.3. Dispute claims where insurer or organisational requirements are not met

1.4. Notify rehabilitation provider  in accordance with organisational procedures

1.5. Advise claimants as to whether their claim has been accepted

1.6. Analyse claims to identify the nature of the illness/injury and prepare report/s

1.7. Identify projected period of absence and where rehabilitation assistance is required, and ensure arrangements are made in the work team to deal with absence

2. Establish rehabilitation/return to work program

2.1. Ensure consultation occurs between rehabilitation provider and treating doctor

2.2. Ensure consultation occurs between rehabilitation provider, relevant managers and employee

2.3. Consider job redesign, reduced hours and alternative duties  in the light of medical advice

2.4. Design a rehabilitation/return-to-work program to achieve a successful return-to-work

2.5. Obtain approval for return-to-work program by relevant managers

2.6. Establish rehabilitation program with employee

2.7. Undertake risk analysis  in relation to proposed program and mitigate  risk where appropriate

2.8. Commence program as close to the time of the accident/illness as possible

3. Monitor/evaluate rehabilitation/ return to work program

3.1. Encourage regular feedback/communication between provider, supervising manager and employee

3.2. Organise regular contact and support between provider and employee

3.3. Identify breaches of the return-to-work program and take remedial action promptly

3.4. Refer return-to-work program to workers compensation authorities  where breaches occur

3.5. Modify return-to-work program where appropriate if it is not delivering the required outcomes

3.6. Evaluate  each rehabilitation/return-to-work program at its conclusion and implement recommendations for system improvement where appropriate

REQUIRED SKILLS AND KNOWLEDGE 

This section describes the skills and knowledge required for this unit.

Required skills 

• communications skills to discuss health matters sensitively with a range of people and to represent the employer for disputed claims
• negotiation skills to negotiate disputed claims
• organisational and administrative skills to see that all claims are properly processed and that claimant is clear about what is happening and what to expect.

Required knowledge 

• rehabilitation concepts and return-to-work procedures
• relevant legislation from all levels of government that affects business operation, especially in regard to workers compensation, occupational health and safety and environmental issues, equal opportunity, industrial relations and anti-discrimination
• workers compensation tribunal procedures.

EVIDENCE GUIDE 

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.

Overview of assessment 

Critical aspects for assessment and evidence required to demonstrate competency in this unit 

Evidence of the following is essential:

• critical analysis of the organisation's rehabilitation return-to-work programs
• assessment of the strengths and weaknesses of the organisation's approach to rehabilitation return-to-work programs
• knowledge of relevant legislation.

Context of and specific resources for assessment 

Assessment must ensure:

• access to appropriate documentation and resources normally used in the workplace.

Method of assessment 

A range of assessment methods should be used to assess practical skills and knowledge. The following examples are appropriate for this unit:

• analysis of responses to case studies and scenarios
• assessment of written reports
• direct questioning combined with review of portfolios of evidence and third party workplace reports of on-the-job performance by the candidate
• observation of performance in role plays
• oral or written questioning to assess knowledge of workers compensation tribunal procedures
• review of risk analysis undertakenof a proposed return-to-work program
• evaluation of contact and support organised between provider and employee.

Guidance information for assessment 

Holistic assessment with other units relevant to the industry sector, workplace and job role is recommended, for example:

• other units from the Diploma of Human Resource Management.

RANGE STATEMENT 

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Claims  may include:

• sick leave claim/application
• workers compensation claims

Rehabilitation provider  may be any authorised health professional including:

• case managers
• counsellors or psychotherapists
• pain or injury management specialists
• physiotherapists

Alternative duties  may include:

• limited range of duties in their normal job
• new position
• specific tasks which will not aggravate the injury or condition

Risk analysis  means:

• determination of the likelihood of a negative event preventing the organisation meeting its objectives and the likely consequences of such an event on organisational performance

Mitigation  means:

• action taken to reduce or eliminate risk identified

Workers compensation authorities  means:

• relevant body, court, tribunal or commission having jurisdiction in respect to workers compensation matters

Evaluation  means:

• determining the extent to which the program meets its objective in respect to timeframes, success rates, cost and impact on the organisation

Unit sector 

Competency field 

Workforce Development - Human Resource Management

Co-requisite units