Better relationships, better outcomes - Tips for insurer case managers

A PDF version of this factsheet is also available.

Effective GP relationships benefit workers

As a case manager, you are one of two key support people that a worker relies on to assist with their recovery at/return to work, treatment arrangements and payments. The other is the worker’s GP. By working effectively with the GP, you can help the worker return to health, work and wellbeing in a timely way.

The State Insurance Regulatory Authority has developed the following tips in consultation with industry stakeholders to improve insurer-GP interactions.

Communicate well

• Clearly explain why you’re contacting the GP. Use plain English and avoid jargon.
• Be more personal by focussing on the individual patient, not the process.
• Tailor your questions and minimise the number of questions you ask. You may need to seek help from within your organisation (from an injury management advisor or other medical person).
• If a case conference has been organised, send the GP an agenda that you or the organising party have prepared.
• Coordinate the worker’s support team communications to avoid duplicate information going to the GP.

Make contact at the right time

• Contact the GP early, especially if the worker is at risk of delayed recovery.
• Be mindful of the GP’s busy schedule. Find out how and when the GP prefers to communicate (by phone, or email, or during certain hours or days).
• Make an appointment with the GP to have a conversation about the worker (this may have to be after business hours) and give the GP a brief list of questions beforehand.
• Respect agreed timeframes or commitments you make with the GP, including responding to requests in a timely manner.

Respect the GP’s skills

• Acknowledge the GP’s medical expertise and any pre-existing doctor-patient relationship.
• Positively reinforce your shared interest in their patient’s recovery and working together to ensure the best health and work outcomes for the patient.
• Set mutual expectations with the GP by letting them know your role and how you can help them.
• Ask the GP to estimate their patient’s expected recovery time based on previous experience.
• Give the GP an opportunity to discuss and respond to proposed referrals to non-treating medical professionals (for example, an injury management consultant or independent medical examiner).

Be transparent

• Be open and honest.
• Give the GP your name and direct contact number.
• Let the GP know they can be paid for discussing the patient’s injury management and return to work with you.
• Provide guidance and support if the GP is unsure of their role in the NSW workers compensation system. Their role can vary depending on the insurer and the size of the employer. Provide the GP with information about the patient’s pre-injury work.
• Share information from other treating practitioners (for example, the allied health recovery request or reports from the workplace rehabilitation provider), to help the GP complete the certificate of capacity and plan the patient’s recovery at or return to work (if appropriate).
• Let the GP know when you have approved (or declined) treatment and referrals.

Other things you can do

Think strategically: Consider risk profiling to focus your time and efforts based on risk.

Plan the relationship: If you have identified that GP engagement is a priority with a particular claim, it may be better to meet the GP face-to-face.

Evaluate your engagement: Consider how well you engaged with each GP. Document what worked, what didn’t, and learn from the process.