Hobart Occupational Medicine has developed a brief report format designed to assist claims staff make decisions about liability and claims management during the initial period following lodgement of a claim. The concept is based on the early identification of the prognosis, using an assessment of an array of factors including diagnosis, previous history, clinical/investigation findings, psychosocial factors, the type of work and other related employment factors. The report would categorise the claim as simple or complex and provide information to claims officers to assist them to determine causation and the likely resources to manage the claim, but without the assessing doctor providing a formal opinion about causation. The purpose of the report is to aid claims decisions rather than to be used as a formal medico-legal report.
For this approach to be effective and fit within the 84-day period an insurer has to assess their liability, the turnaround for a report would need to be prompt. The claims officer would arrange an appointment for the worker to see the assessing doctor with an appointment being made available within a week of the request. The report format is necessarily brief so that the assessing doctor could complete the form at the time of the assessment and return to the insurer on completion of the assessment, rather than having to dictate a detailed report.