• Section 1 - Purpose
• Section 2 - Scope
• Section 3 - Responsibilities
• Section 4 - Procedure/Process
• Section 5 - Document Review

Section 1 - Purpose

(1) This procedure sets out a framework at the Catholic Diocese of Maitland-Newcastle (the Diocese) for conducting internal Injury Management and Return to Work audits on claims as a means of identifying areas of strength and potential improvement in the internal management of claims.

Section 2 - Scope

(2) This procedure applies to all workers of the Diocese (including its agencies, and parishes if decreed by the Bishop) who are involved in injury management and responsible for managing workers’ compensation claims.

Section 3 - Responsibilities

(3) Please refer to the Return to Work Procedure.

Section 4 - Procedure/Process

(4) Effective claims management and administration will ensure consistent process and management actions across the Diocese’s workers’ compensation claim portfolio.  The objective of these internal audits is to identify areas of strength and potential improvement in the internal management of claims to ensure continuous improvement occurs.

Determining Audit Sample

(5) A sample of a minimum of 5 claims per each Injury Management and Wellness Specialist should be audited.

Frequency Of Audits

(6) Audits of the sample of claims should occur on a bi-annual basis.

Who Undertakes The Audit

(7) Each Injury Management and Wellness Specialist should be responsible for auditing claims of another Injury Management and Wellness Specialist.

Audit Criteria

(8) The audit is to be completed using the ‘Claims Audit Tool’.

Implementing Changes

(9) Following the audit, the results are to be shared with each Injury Management and Wellness Specialist and the Health and Wellness Manager. It is recommended that the following quarter the team focuses on one area to improve on based on audit findings i.e. ensuring that the Injury Management and injured worker's line manager are involved in a case conference if the worker is certified unfit, evidence of the line manager contacting the worker at regular intervals, and ensuring a signed Recover at Recover at Work Plan (RAW plan) is on file. 

Section 5 - Document Review

(10) This procedure will be reviewed when there is a legislative change, organisational change, delegations change, technology change or at least every 2 years in conjunction with the review of the Return to Work Program.