WORK CAPACITY ASSESSMENT PROCEDURE FAIR AND REASONABLE, SAYS MINISTERAccident Insurance
"The details of the new ACC Work Capacity Assessment Procedure (WCAP) will be tabled in Parliament next week. The intention of this move is to see that ACC resources go to those who most need them," the Minister for ACC Jenny Shipley said today.
Mrs Shipley today released the final version of the WCAP, which ACC will start implementing once it has been tabled.
"This new procedure will be used to assess the capacity for work of ACC clients who have completed a vocational rehabilitation plan and continue to receive weekly compensation. It will be one of a number of tools available to ACC staff as they manage the ACC scheme in the interests of both claimants and premium payers.
"The Government's goal is to assist people who have been injured to return to work when they are fit and ready to do so.
"It is important that people are not abandoned to languish on weekly compensation when it would be in their own interests to be back at work. It is also important that New Zealanders are not paying ACC premiums to support people who are capable of working and supporting themselves.
"ACC is putting more resources into rehabilitation to assist people to either return to their previous jobs or develop new skills. The WCAP ensures that decisions about when a person is ready to return to work are made in an appropriate way, through professional assessment by both medical specialists and qualified and experienced occupational assessors.
"The WCAP has two separate steps:
An occupational assessment will answer the question "what could this person do?"
A medical assessment will then answer the question "are they fit to do it?"
"If answers are found to both these questions that show a person is able to do work for which they are suited for more than 30 hours a week, then they will be given three months to find a job. At the end of that time, their weekly compensation will cease, and if they have not found a job they will have to apply for the unemployment benefit like all other New Zealanders.
"The WCAP has been trialed by a group of claimants, and almost three-quarters of the trial group agreed it was a fair and reasonable procedure. It has been reviewed by independent assessors and there have been two rounds of public consultation.
" During that process there has been considerable criticism of the scheme from some quarters, with opposition politicians making wild and totally unfounded allegations that thousands of ACC claimants will be dumped from the scheme or forced into menial jobs against their will.
"There is no question that ACC will continue to support people whose injuries are so serious they are not able to work. ACC will also ensure that every person assessed has access to all the rehabilitative support they need before any decision is made on whether they are capable of working.
"The WCAP will be introduced gradually, as ACC works through its records to decide which claimants will go through the new procedure. Because this will only affect those who have completed their vocational rehabilitation and are able to work more than 30 hours a week, ACC expects the numbers affected to be in the hundreds rather than the thousands.
"New Zealanders using their common sense will understand that the question of whether people genuinely need to be on ACC, or whether they are capable of supporting themselves, must be tackled. It is a matter of balancing fairness against personal responsibility.
"I am confident that the WCAP is the most fair and reasonable way of achieving that," Mrs Shipley concluded.
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The Work Capacity Assessment Procedure
Questions & Answers
What is the work capacity assessment procedure?
The work capacity assessment procedure (WCAP) has been developed by ACC as a result of changes to ACC?s governing legislation in September 1996. The WCAP provides ACC and claimants with an independent assessment of a claimants? capacity to work.
When will the work capacity assessment procedure be used?
The WCAP will be used for claimants who have completed their vocational rehabilitation plan, which was agreed in partnership between the claimant and their case manager, and are still receiving weekly compensation. The WCAP independently determines whether a claimant is prevented from returning to work due to an injury related factor or for some other reason.
What does the work capacity assessment procedure do?
The WCAP considers a claimant?s capacity to work in jobs for which they are suited by reason of their education, experience and/or training, having regard for the consequences of the claimant?s personal injury.
Claimants who are found to have a capacity to work, will have their weekly compensation stopped after three months. Claimants who are found not to have a capacity to work, will have their weekly compensation continued and will be provided with further rehabilitation.
How does the work capacity assessment procedure work?
The WCAP comprises two separate assessments. In the first, an occupational assessment, the claimant meets with a qualified occupational assessor. The occupational assessor, in consultation with the claimant, makes a list of jobs for which the claimant is suited by reason of his or her education, experience and training. The occupational assessor will consider any new skills a claimant has acquired since the accident.
In the second assessment, a medical assessment, the claimant will meet with a qualified medical assessor. The medical assessor carries out a medical examination of the claimant to determine the effects of the claimant?s injury. The medical assessor will then recommend to ACC, which of the job options the claimant can do for more than 30 hours per week. If the claimant has a special need, the medical assessor may request an additional assessment with a specialist, experienced in the claimant?s condition, before making a recommendation.
If the medical assessor recommends to ACC that the claimant is able to do one or more of the identified job options, then the claimant is deemed to have a capacity to work.
If the claimant is unable to work due to an injury related factor, then the medical assessor recommends to ACC specific rehabilitation objectives for the claimant to obtain a capacity to work.
Should the medical assessor recommend to ACC that the claimant is not prevented from working by his or her injury, but cannot work due to a non-injury related factor, such as illness, then weekly compensation will also be stopped after three months.
What happens before a claimant is referred to the work capacity assessment procedure?
Referral of claimants to the work capacity assessment procedure happens only when their vocational rehabilitation plan has been completed. The following steps will be followed before a claimant is assessed using the procedure:
a vocational rehabilitation plan is completed and the case manager is satisfied that suitable rehabilitation has been provided; and
the case manager uses the selection criteria form to seek approval to use the procedure from an internal panel.
This internal panel, which comprises a branch medical advisor and a senior case manager discusses the claimant?s situation with the case manager. The panel needs to be satisfied that:
the vocational rehabilitation plan contains achievable objectives and strategies that reflect the needs assessment or initial evaluation;
the vocational rehabilitation objectives and strategies were specific;
alternative job options were identified in the rehabilitation process;
there is no outstanding medical treatment which would preclude a return to work of 30 or more hours a week.
If the panel is not satisfied that the above conditions are met, then the claimant cannot be referred for assessment.
How will claimants be selected for the work capacity assessment procedure?
Claimants selected for the procedure must:
be receiving weekly compensation; and
have completed a vocational rehabilitation programme that had suitable alternative occupations identified and agreed upon.
How many claimants will be affected by the work capacity assessment procedure?
While there are approximately 9000 claimants who have been identified from ACC?s computer system as being potentially eligible for the work capacity assessment procedure, the majority of these claimants do not currently meet the necessary criteria. Many have not completed their vocational rehabilitation, or can only work part-time. Each claimant file will need to considered carefully before a decision to use the procedure can be made. It is anticipated that the number of claimants to be assessed in the next twelve months, will be measured in the hundreds rather than the thousands.
>From ACC?s perspective, it is preferable that claimants return to work through improved vocational rehabilitation rather than through the work capacity assessment procedure. To this end, ACC is undertaking a nation-wide vocational rehabilitation training for staff, to increase staff competence in providing vocational rehabilitation to claimants.
What if there are no jobs where the claimant lives?
Legislation requires that the procedure only considers work for a which a claimant is suited by reason of his or her education, experience and/or training, having regard for the claimant?s personal injury.
Legislation does not require the procedure to consider the availability of work, how much a claimant was earning at time of injury, or where the claimant lives. However, it is important to point out that the rehabilitation plan which the claimant has agreed to and completed, should have included the issue of availability of jobs in the occupation upon which it has been based.
Claimants unable to find work once their weekly compensation has stopped will be in the same predicament as any other New Zealander, who through no fault of their own, is unemployed.
Will claimants who were in a highly skilled job at the time of injury, assessed as only having a capacity to work in a menial job, lose their weekly compensation?
The objective of vocational rehabilitation is to return a claimant as much as possible, to their pre-injury position. This means that a highly skilled person, unable to return to their pre-injury job, will at the conclusion of rehabilitation have skills to work in a different occupation at a similar level. As the work capacity assessment procedure cannot be used until after all the objectives in the rehabilitation process have been completed, claimants referred for work capacity assessment will have the skills and qualifications to perform the occupation agreed to in the vocational rehabilitation plan.
Previously highly skilled claimants who, as a result of injury, are so severely injured that vocational rehabilitation can not assist them to obtain the skills for a suitable alternative job, will not be referred to the work capacity assessment procedure.
What happens if the work capacity assessment procedure determines that a claimant has a capacity to work?
The claimant?s weekly compensation will be stopped after three months. During that time, the claimant?s case manager will provide assistance, if necessary, to transfer to the New Zealand Employment Service or Department of Social Welfare if the claimant is eligible for income maintenance, such as unemployment, sickness or invalids benefit.
Their case manager will also be available to discuss and support, any job search activities the claimant undertakes.
What happens if the work capacity assessment procedure determines that a claimant does not have a capacity to work?
The case manager will discuss with the claimant, the recommendations for further rehabilitation made by the medical assessor. The case manager and the claimant, will then prepare a new rehabilitation plan to implement these recommendations. When this rehabilitation plan is completed, the claimant will be required to meet the medical assessor again for reassessment.
Can claimants appeal the work capacity assessment procedure decision?
As with all other decisions made by ACC, claimants can seek a review or an appeal of the WCAP decision.
What happens if a claimant?s condition deteriorates after their weekly compensation has been stopped?
If a claimant?s condition deteriorates after being assessed as having a capacity to work, they will be reassessed in the work capacity assessment procedure. If the claimant was earning at the time of the deterioration, then they will be eligible for weekly compensation.
Can claimants take someone with them to the assessments?
Claimants may take family, whanau or other support people with them to the assessments. In the unlikely event that a claimant has to travel to another centre for an assessment, then the transport cost for support people will have to be met by the individuals concerned.