The WorkSafe Clinical Panel

Worksafe clinical panel

The WorkSafe Clinical Panel is a group of medical practitioners and other health professionals who undertake clinical reviews and provide clinical and rehabilitation support and advice to WorkSafe staff, insurance companies (EML, Allianz, xChanging and Gallagher Bassett, as well as self insurer’s) and healthcare providers. The WorkSafe Clinical Panel is funded by WorkSafe.

We’ve noticed that the WorkSafe clinical Panel has become more and more common as a reference and assessment tool for WorkCover insurer in recent times.

This page will look at who the WorkSafe Clinical Panel are, and their ever increasing role in WorkCover matters in Victoria.

Who is on the WorkSafe Clinical Panel?

There are is a wide variety of medical practitioners and health providers on the WorkSafe Clinical Panel.

Specialties that are used by the clinical panel include the following:

Occupational and Environmental Medicine, Occupational Therapists, Rehabilitation Medicine, Pain Medicine, General Practice, Physiotherapists, Medical Practitioners, Psychiatry, Chiropractors, Addiction Medicine, Clinical and Health Psychologists, Sport and Exercise Medicine, Audiologists, Prosthetists, Pharmacists, Dentists, Osteopaths.

What is the Criteria for a doctor or health provider to be on the Clinical Panel?

WorkSafe state that those on the Clinical Panel must meet criteria before they can be considered to be eligible for entry on the Clinical Panel register.

The criteria are:

1. Are they current registered by the Health Practitioner National Registration Law (Victoria) Act 2009?

2. Are they appropriately insured?

3. Have they worked for a minimum of 5 years direct clinical care as a practitioner in their chosen discipline?

4. Do they currently maintain an active clinical practice of at least 8 hours per week?

5. Do they currently hold a membership with a relevant peak professional association?

6. Do they meet the continuing professional development requirements of the relevant registration board?

7. Are they able to work from the Worksafe office or an office of an insurance company?

In what instances are the WorkSafe Clinical Panel being used?

Here are some examples as to how we’ve seen the WorkSafe Clinical Panel used recently in relation to some of our client’s WorkCover matters.

Psychiatric impairment assessments of 30% or greater

We have seen the WorkCover insurer refer impairment assessments of 30% or greater to the clinical panel for review (and potentially for an opinion with respect to an appeal).

Spinal surgery

This is the main area in which we have seen the clinical panel used. Our understanding is that any request for spinal surgery is reviewed by the WorkSafe Clinical Panel and that this is a mandatory process.

Opinions on physical therapies such as physiotherapy

The clinical panel is asked in these situations to review the effectiveness of the treatment and advise work cover insurer as to whether the treatment should continue. They may also match the treatment against the clinical framework for the delivery of health services document produced by WorkSafe Advisory.

Communicating with your doctor

It may be that a clinical panel member speaks with your doctor to discuss your treatment and future treatment options.

Discussions with your doctor cannot result in directing your doctor to treat you in any particular way or give or withhold treatments.

The clinical panel may make suggestions regarding your treatment but they are not binding on anyone though obviously the insurer may use that opinion to affect your entitlements.

How long does a Clinical Panel review or opinion take to obtain?

The time that it takes a clinical panel to provide an opinion in a matter varies from specialist to specialist and from issue to issue.

We have seen instances of clinical panel opinions not being provided for months.

And there is no set mechanism in place to follow up a delayed clinical panel opinion.

We have followed up directly with WorkSafe and insurers regarding delays for our clients in receipt of clinical panel opinions and the knock on effect to our clients claims.

Ultimately the WorkCover insurer must still make a decision after receiving a clinical panel opinion.

This means that you will always have the ability to challenge a decision made by a work cover insurer that relies on a clinical panel opinion.

Is an opinion of the Clinical Panel binding?

Clinical panel opinions are not binding on any party and do not have the same effect as a medical panel opinion which is a different entity.

Conclusion

The clinical panel undertake clinical reviews and provide clinical and rehabilitation support and advice to WorkSafe’s claims staff, agents and healthcare providers.

The WorkSafe Clinical Panel is becoming a more prominent tool used by WorkCover insurers to assess workers entitlement to medical and like expenses.

This is particularly the case with spinal surgery which is always reviewed by the clinical panel.

if you are experiencing delays in your treatment due to having to wait for a clinical panel opinion not being provided, feel free to contact us for confidential advice.

Please keep in mind that the information contained on this page should not be considered legal advice and no content on this site should replace the need to obtain advice tailored to the specific facts of your case. The facts of a case can significantly alter the advice that can provided. This site only provides general advice. Read more here.

To contact Michael or Peter call 1800 746 442 or email [email protected].

Written by the Work Injury Site team