Workability Conference 2004

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Workability Conference 2004
Garry Wilson, Chief Executive Accident
Compensation Corporation
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Returning People to Work after Injury

• ACCs Systematic Approach

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What is ACC?

• Accident Compensation Corporation
• ACC provides comprehensive 24-hour, no-fault
  personal injury cover
• For all NZ citizens, visitors
• No right to sue for injury

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ACCs Mission

• Injury arising from accident demands an attack
  on three fronts. The most important is obviously
  prevention. Next in importance is the obligation
  to rehabilitate the injured. Thirdly, there is
  the duty to compensate them for their losses.
• Sir Owen Woodhouse, 1967

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Unique Scheme

• NZ first country to make these commitments
• 4 million New Zealanders
• 1.6 million claims year
• ACC spends 1.4 billion on treatment,
  rehabilitation, weekly compensation, injury
  prevention

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Injuries New Zealand 2003/04

• 1,070 people killed
• 103,000 injured moderately/seriously
• 1.6 million minor injuries

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Key Areas for Moderate/Serious Injuries

• Workplace 33,988
• Home Community 24,768
• Sport 16,642
• Road 4,627

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How ACC is Funded

• Work accounts
• Employers Account
• Self-employed Work Account
• Earners Account
• Non-work accounts
• Non-earners Account
• Motor Vehicle Account
• Residual Claims Account
• Medical Misadventure Account

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Rehabilitation Expenditure

• Medical treatment 278M
• Public health acute 269M
• Social rehabilitation 238M
• Hospital treatment 119M
• Conveyance 41M
• Vocational rehabilitation 34M
• Dental 12M

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Claim Distribution
Medical
0.5
4.5
treatment only
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Minor injuries
minimum time
off work
More
complicated
85
injuries
Serious
injuries
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The Cost of Injuries

• 22-year-old male, fully ventilated quadriplegic
  (est. 41 years to live) 14,243,000
• 19-year-old female, lower level paraplegic (est.
  51 years to live)
• 5,854,000
• It takes 95,000 motor vehicle levies to meet the
  lifetime costs of 5 seriously injured children

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Definition of Rehabilitation

• A process that aims to restore a claimants
  health, independence and participation as close
  as practicable to pre-injury state
• Comprises treatment, social rehabilitation, and
  vocational rehabilitation

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Rehabilitation ServicesFunded by ACC

• Treatment
• Primary Care
• Specialist
• Hospital based
• Diagnostic
• Rehabilitation
• Vocational Rehabilitation
• Social Rehabilitation

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ACCs Return to Work Strategies

• Early notification
• Screening
• Early assessment
• Early intervention
• Case management of complex claims
• Lifetime Rehabilitation Planning

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Case Management

• Electronic claiming
• Contact Centres (telemarketing-style case
  provision)
• In touch
• Determine needs
• Case managers in branches
• Lifetime care planners (for most serious)

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Increased Focus on Rehabilitation

• Early assessment
• Effective treatment without delay
• Focus on quality
• Intensive case management by branch network for
  moderate to serious injury claims
• Caseloads down from
• 93 to 69 per
• case manager.

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Strategies to achieve Rehabilitation Objectives

• purchase additional elective surgery
• involve providers in designing our services
• just released Guidelines for Medical Assessors
• developing Guidelines for Occupational
  Assessors
• develop national treatment profiles (ankles,
  knees, backs, shoulders)
• developing treatment profiles for nurses
• match supply of contract providers to demand
• programmes target a return to work for seriously
  injured claimants.

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Rehabilitation Model
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Individual Rehabilitation Plan

• By 13 weeks
• Developed in consultation - case manager,
  claimant, claimants representative, treating
  medical practitioner, employer or potential
  employer
• Charts path for rehabilitation
• Medical disability advisor
• Professional advice from all sources

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Lifetime Rehabilitation Planning

• Specialist case managers
• January 2003
• Most seriously injured
• Confirms levels of support, e.g. car, housing
  modifications going forward
• Sets expectations/goals

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Vocational Rehabilitation

• Maintain employment (same employer, same
  industry)
• Obtain employment
• Regain or acquire vocational independence

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Vocational Rehabilitation

• Focuses on claimants individual needs
• Addresses injury-related barriers
• Also takes into account other barriers (e.g.
  alcoholism, literacy)

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Vocational Rehabilitation

• Flexible - suited to claimant
• Comprehensive - IRP lists all needs
• Integrated - along with treatment social
  rehabilitation

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Illustration Brain Injury (1)

• ACC manages ongoing claims of 5000 individuals
  who have suffered a brain injury
• ACC receives 17,000 new claims for concussion year

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Illustration Brain Injury (2)

• Mild Traumatic Brain Injury Service diagnoses
  either
• Mild TBI or
• Post Concussional Syndrome
• Identifies claimants at risk of long-term
  disability

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Illustration Brain Injury (3)

• For most with mild TBI, the service develops
  multi-disciplinary treatment and rehabilitation
  plan
• The Employment Maintenance Programme helps people
  return to pre-injury jobs

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Illustration Brain Injury (4)

• Professional interviews claimant
• Visits worksite to identify issues
• Develops time-framed return to work plan
• Monitors progress

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Illustration Brain Injury (5)

• Fatigue often an issue
• ACC supports gradual increase in working hours
  tasks
• Provides equipment to help
• Facilitates pain management

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Illustration Brain Injury (6)

• Claimants unable to return to pre-injury job have
  an
• initial occupational assessment
• initial medical assessment
• An employee with cognitive impairment may need
  help to move to new job or support to improve
  cognitive skills

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Illustration Brain Injury (7)

• Work Ready Programme prepares claimants for
  full-time employment in specific occupations
• Monitored work trial
• On the job training 3-6 weeks
• Workplace assessment
• 4-week extension possible

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Illustration Brain Injury (8)

• Work Preparation Programme helps claimants unable
  to return to pre-injury work not work ready
• Six-week programme gives physical, psychological,
  vocational training
• Claimants rejoin employment pool

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Illustration Brain Injury (9)

• Transitional Job Search Service for people whose
  entitlement is ceasing
• ACC works with the Work Income Service, to find
  work (12-weeks)

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Illustration Brain Injury (10)

• ACC developing monitoring tools to assess
  provider performance
• ACC delivers vocational services for people with
  serious injuries case by case
• ACC now exploring feasibility of systematic
  delivery

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Comparison of Claim Costs
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Long term claims - entries and exits
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ACC rehabilitation expenditure as a percentage of
total expenditure

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New Zealand days off work after injury, over time

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Non-return to work rates after nine months -
2001/2


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Early Intervention

• Workplace assessments
• Equipment
• Short training courses
• Functional capacity evaluation
• Vocational assistance

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Vocational Independence

• Initial Occupational Assistance
• Initial Medical Assessment
• Vocational Independence Assessment
• Work Preparation Programme
• Work Ready Programme
• Transitional Job Search

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Vocational Programmes

• Employment Maintenance
• Graduated Return to Work

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Recent Initiative

• Kaleidoscope Programme
• Spinal Unit
• Early intervention
• Pilot
• One in four spinal patients work
• Switzerland - 87

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Improvements in Six Years

• After serious accidents
• 87 of people were back at work in 12 months
  now 6 months
• average time off work was over 6 months now
  under 3 months
• median time off work down by 1 week
• 93 rehabilitated by 12 months.

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Thank You
www.acc.co.nz