Injury management team’s new pathway results in speedy recovery post injury

Risk Matters - Spring 2023

A fresh, new approach to handling claims is already delivering benefits to claimants, members and saving money.

The new injury management pathway went live on 1 July 2023 and has changed the way that LGIS handles new and emerging workers’ compensation claims with early notification support services.

Our injury management team are all allied health professionals and draw on clinical knowledge and skills to work in collaboration with trusted providers. The team identifies high risk claimants and intervenes to support better recovery and return to work outcomes.

Services include early intervention access to specialised physiotherapists, and latest technology to reach our rural remote clients who have limited access to therapy, support with development of return-to-work plans, access to psychologists, and support for general practitioners by psychiatrist on how to best manage mental health claims.

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Case Study: Worker resumes full time work hours with early notification

A female worker in her 50s slipped on a wet ramp and fell on her outstretched left hand in June 2022. She suffered a shoulder injury and had surgery.

She complained of persistent pain and limited functional improvement in terms of her work even after surgery.

LGIS refers worker to specialists

The workplace rehabilitation provider at the City flagged the worker’s lack of improvement to LGIS’ injury management advisor (IMA) this year following the surgery.

Our IMA assessed the situation, liaised with the treating physiotherapist, and identified that the worker was presenting with key pain makers post-surgery that could result in the development of chronic pain syndrome. Our IMA arranged a referral for a specialist physiotherapist review after gaining consent from the worker.

The specialist physiotherapist undertook a comprehensive assessment, including reviewing the workers medical information, addressing her concerns, and formulating a treatment plan to resolve the identified issues.

The outcome

After a six-week treatment, the worker went for a follow-up review and found improvement in her condition.

The result of the specialist physiotherapist referral was the finalisation of a complex claim.

Specialist physiotherapists are highly trained and experienced physiotherapists who are recognised as being at the top of their field. They are able to break down not just the physical, but also the psychosocial contributors of pain and injury often leading to far superior results than just treating the physical injury alone. They work collaboratively with treating providers and provide expert opinions on treatment and rehabilitation.

Lessons learned

  • Having a collaborative relationship with our members and providers enables LGIS to work faster and smarter to ensure workers are provided with the best support possible to optimise their recovery.
  • Due to the rehabilitation provider flagging this worker’s high pain level, the IMA was able to utilise their clinical skills
    to liaise with treating providers and identify the need for a specialist physiotherapist review.
  • Without the specialist physiotherapist’s intervention, the claim could have remained open for another 6 – 12 months, if not longer, which would have negatively impacted both the worker and member.
  • It is important to note here that post surgery, the worker used to work four hours a day for four days a week. Once the physiotherapy intervention was successful, she returned to normal full-time hours.

After seeing him (the specialist physiotherapist) and talking through my pain with him, I suddenly started shooting goals. I was referred to see him as I had a shoulder injury that even after surgery was agonising. He understood my hypersensitivity and the shielding that I was doing unconsciously. He helped me to an extent that after my six week review I got a gold star. Today my claim was finalised.”

Case Study: Surgery avoided with specialised support plan

A worker from a metropolitan member sustained a left knee injury causing meniscal tearing, a condition in which forceful twisting causes certain tissue in the knee to tear. The general practitioner (GP) referred the worker for an immediate imaging and surgical review. The claim was lodged with LGIS.

LGIS injury management intervention: Initial triage

All new claims are triaged by the IMA team within the first 1- 2 weeks of a claim being lodged with LGIS. Upon review, the IMA identified that this worker would be a good candidate for the recovery options review (ROR) by a specialist physio service. This is an early intervention physiotherapy service to support setting a worker up for success when they have injuries and address any negative perceptions or beliefs from a worker about their injury and recovery.

LGIS’ IMA initiated contact with the worker and engaged him with the ROR prior to his appointment with a surgeon. The worker told the IMA that prior to the ROR sessions he experienced numbness and pain in his knee. After the review, he reported feeling better about his knee and his pain had improved. He advised that the ROR physiotherapist took the time to listen to him, answered his questions about his knee and provided treatment that resolved the numbness he was experiencing.

Following the consultation with the ROR, the worker was reviewed by his treating surgeon who encouraged him to continue with conservative treatment with the ROR team to see how he goes.

What is conservative treatment?

Conservative treatment – It is a treatment that supports recovery without surgical intervention.

After a six-week physio treatment, the worker had a ROR follow up, where his lower extremity functional scale improved from 45% to 97.5%. The lower extremity functional scale (LEFS) measures a patient’s initial function, ongoing progress, and outcome for a wide range of musculoskeletal conditions.

The worker is now completing a self-managed exercise program and has been upgraded to his pre-injury duties and is nearing a final medical certificate being issued.

Lessons learned

  • Not all injuries require surgery, and most can be managed conservatively. By providing specialised services at the start of the claim, this worker avoided surgery (estimated costing of $10 000- $15 000), which would have resulted in six weeks off work, a graduated return to work over 6- 12 weeks once provided with a capacity and intensive physiotherapy and exercise rehabilitation (estimated cost of $4000 – $8000).
  • Early interventions on claims are not just about saving money for our members, but also improving the claims experience for the worker. In this case, this worker reported feeling well supported and decided to not undergo surgery as he felt he was recovering better with physiotherapy support.

LGIS new injury management early intervention protocols, designed to identify medium to high risk claims and apply appropriate services, are already supporting members with better claims outcomes.

For more information on the early intervention services provided by the LGIS injury management team, please email your queries at [email protected]

Have a question you'd like answered?

Each month we take your questions to one of our LGIS team members to answer.

If you want to submit a question for next issue, email us at [email protected]

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