Are Your Workers Compensation Claims Getting Out of Control?

Return to work is not just paperwork

A return to work process should not be treated as a form that gets completed once and forgotten.

A proper return to work process should be active, practical and regularly reviewed. It should help the business answer key questions such as:

• What is the worker currently certified fit to do?
• What duties are suitable and safe?
• What restrictions or limitations apply?
• Who is communicating with the worker, doctor, insurer and supervisor?
• What adjustments are required in the workplace?
• When will the plan be reviewed?
• What evidence is being kept to show the business has acted reasonably?

SIRA states that employers have a responsibility to facilitate recovery at work after a work-related injury, including identifying and providing suitable work.

This is where many businesses get stuck. They may receive a certificate of capacity, but they do not know how to translate that into safe, meaningful and documented suitable duties. The result is often either no duties being offered, duties being offered informally, or duties being offered without proper consideration of the worker’s restrictions.

Why early action matters

The first few days after an injury are important.

A delayed response can create confusion and frustration for the injured worker, the supervisor and the business. It can also allow assumptions to form, communication to break down and the claim to become harder to manage.

Early action does not mean pressuring a worker to return before they are medically able. It means making contact, showing support, understanding the worker’s capacity, communicating with the insurer, considering suitable duties and planning the next steps.

A good early response should include:

• checking on the worker’s wellbeing;
• ensuring the injury has been recorded;
• notifying the insurer where required;
• obtaining and reviewing the certificate of capacity;
• identifying safe and suitable duties;
• consulting with the worker and relevant parties;
• documenting the agreed return to work arrangements;
• setting clear review dates.

The NSW workers compensation system is designed to support prompt treatment, effective and proactive management of injuries, rehabilitation and return to work as soon as possible.

Suitable duties need to be genuinely suitable

One of the biggest mistakes businesses make is offering “light duties” without properly considering whether those duties are actually suitable.

Suitable duties should be based on the worker’s current capacity, medical restrictions, workplace risks, skills, location, hours and the operational needs of the business. They should not be token duties, unsafe duties or duties that aggravate the injury.

For example, if a worker has a shoulder injury, suitable duties may involve removing overhead work, heavy lifting, repetitive reaching or tasks requiring sustained force. If a worker has a psychological injury, suitable duties may require careful consideration of workload, supervision arrangements, communication channels, triggers, hours and workplace interactions.

The duties need to be practical and documented. Supervisors also need to understand the restrictions so they do not unintentionally allocate work outside the worker’s capacity.

A suitable duties plan should clearly identify:

• the worker’s certified capacity;
• the tasks they can perform;
• the tasks they must avoid;
• any restrictions on hours, movements, weights or exposure;
• supervision and support arrangements;
• start and finish times;
• review dates;
• escalation steps if the duties are not working.

This protects both the worker and the business.

Poor communication can make claims worse

Many return to work problems are communication problems.

The worker may not know what is happening. The supervisor may not understand the medical restrictions. The doctor may not understand what duties are available. The insurer may be waiting on information. The employer may assume someone else is managing the process.

This is where claims can become messy.

A structured communication process should identify who is responsible for contacting each party and what information needs to be shared. The business should avoid relying on informal conversations only. Key discussions, decisions and agreed actions should be documented.

Good communication should be:

• respectful;
• timely;
• factual;
• consistent;
• focused on capacity and recovery;
• aligned with medical advice;
• documented.

Communication should not involve blame, pressure, threats, assumptions about the worker’s injury, or discussions that could be seen as discouraging the worker from making or maintaining a legitimate claim.

Your supervisors need guidance

Supervisors play a major role in return to work outcomes.

They are often the person allocating daily tasks, checking whether the worker is coping, identifying practical issues and noticing whether duties need to be adjusted. However, many supervisors are not trained in return to work, injury management or workers compensation requirements.

Without guidance, supervisors may unintentionally:

• allocate duties outside the worker’s restrictions;
• make inappropriate comments about the injury or claim;
• fail to report changes in capacity;
• treat the worker differently;
• ignore signs that the duties are not working;
• fail to document issues;
• escalate matters too late.

A good return to work process should give supervisors simple, usable guidance. This may include a copy of the suitable duties plan, restrictions they need to follow, who to contact if duties are not working, and how to report concerns.

Return to work should not sit only with administration or management. It needs to be understood by the people managing the work.

Documentation is your evidence

If a workers compensation claim becomes difficult, documentation matters.

Businesses should be able to show what they did, when they did it, who they consulted, what duties were offered, what medical restrictions were considered, what adjustments were made and how the plan was reviewed.

Poor documentation creates risk because it becomes difficult to prove that the business acted reasonably.

Useful return to work records may include:

• injury reports;
• register of injuries entries;
• insurer notifications;
• certificates of capacity;
• return to work plans;
• suitable duties assessments;
• emails or file notes of communication;
• supervisor instructions;
• review meeting notes;
• changes to duties or hours;
• risk assessments;
• evidence that the worker was consulted.

SafeWork NSW notes that businesses must keep a register of injuries for workers to record workplace injuries or illnesses.

Documentation should be accurate, professional and respectful. It should not include personal opinions, assumptions or unnecessary commentary about the worker.

Return to work and WHS duties overlap

Return to work is often viewed only as a workers compensation matter, but it also has a WHS risk management component.

A person conducting a business or undertaking has duties under WHS laws to manage risks to health and safety. SafeWork NSW confirms that employers and businesses, including PCBUs, have legal obligations under work health and safety laws.

When an injured worker returns to the workplace, the business needs to consider whether the work is safe for that worker in their current capacity. This may require a risk assessment, changes to work methods, modified duties, additional supervision, altered hours, reduced manual handling, changed work location or other adjustments.

This is particularly important where the injury involves:

• manual handling;
• plant or equipment;
• driving;
• working at heights;
• hazardous substances;
• fatigue;
• psychosocial hazards;
• customer aggression;
• remote or isolated work;
• high-risk construction work.

The return to work plan should not create new risks or expose the worker to duties they are not fit to perform.

Your return to work program should not sit in a folder unused

A return to work program is the business’s documented approach to managing work-related injury or illness.

It should explain what will happen if a worker is injured, who is responsible, how claims are managed, how suitable duties are identified, how workers are consulted, how communication occurs and how records are maintained.

SafeWork NSW states that a return to work program must be developed in consultation with workers and any industrial union representing them, be consistent with the insurer’s injury management plan, comply with SIRA’s guidelines and be accessible and communicated to the workforce.

This means it is not enough to have a generic template saved somewhere. The program should reflect the business, the work performed, the available duties, the person responsible for recovery at work, and the way the business actually operates.

At a minimum, a practical return to work program should cover:

• commitment to recovery at work;
• injury notification process;
• insurer details;
• nominated person responsible for recovery at work;
• consultation arrangements;
• communication expectations;
• suitable duties process;
• return to work planning;
• use of workplace rehabilitation providers where required;
• dispute or issue escalation;
• confidentiality and records;
• review and continuous improvement.

Warning signs your return to work process needs attention

Your business may need help with return to work if:

• claims are dragging on longer than expected;
• suitable duties are not being identified early;
• supervisors are unsure what the worker can and cannot do;
• communication with the worker has become tense or inconsistent;
• the business does not have a current return to work program;
• return to work plans are not being documented;
• certificates of capacity are being filed but not actively managed;
• workers are returning without clear restrictions being communicated;
• no one is reviewing the plan regularly;
• claims are increasing in cost, duration or complexity.

These issues usually do not improve on their own. They require structure, communication and clear documentation.