Obtaining Approval for Retraining

Published: 9 November 2011

When a worker has suffered a work injury and cannot return to their pre-injury employment, retraining for alternative employment becomes an important consideration in the rehabilitation of the injured worker.  Whose approval does an injured worker need in order to participate in retraining and what can an injured worker do if the approval is not given?

 

If the cost of the retraining is to be covered in a rehabilitation programme or rehabilitation and return to work plan, the approval of the case manager is required.  If the worker undertakes the retraining without it being included in a rehabilitation programme or plan, the cost may not be recoverable from the compensating authority.  In addition, even if the retraining does not cost anything but the worker’s participation in the retraining will affect the worker’s availability to undertake alternative duties that are available, the case manager’s approval is required to avoid any argument about the worker’s ongoing entitlement to income maintenance.

 

Usually, the request for approval of retraining is made through the rehabilitation consultant assigned to the worker.  It is the rehabilitation consultant’s role to assist the worker to identify retraining options that will assist the worker’s rehabilitation and return to work and write to the case manager seeking approval for the retraining to be included in the worker’s rehabilitation programme or plan.

 

The case manager will approve the request if the retraining meets certain criteria.  For case managers with WorkCoverSA’s claims agent, Employers Mutual, the criteria or “principles” are set out in Chapter 7 of the WorkCover Injury and Case Management Manual.  These principles cover a range of situations and include requirements such as:

The retraining assists the worker to retain skills and work condition during their rehabilitation;

The worker has insufficient marketable, transferable skills with which to seek new suitable employment and retraining will improve their prospects of obtaining suitable employment;
The worker’s ability and motivation to adapt to the recommended training and suitable employment outcome has been thoroughly explored; The retraining and subsequent suitable employment options are cost effective;
The retraining improves the worker’s employment potential;
The retraining will return the worker to sustainable suitable employment.

Case managers with self-insured employers have their own separate guidelines to apply when considering requests for retraining.

 

If a rehabilitation consultant refuses to seek the case manager’s approval for retraining, what can the injured worker do about it?  In this situation, the worker should write directly to the case manager requesting that the desired retraining be included in the worker’s rehabilitation programme or plan.  It is important that the request contains full details of the retraining he or she wants to do.  If the retraining consists of a course at a TAFE or other educational institution, the details should include the name of the course, venue, cost, date of commencement, attendance times and duration.  Reasons for wanting to undertake the retraining should also be given.  A medical certificate from the worker’s treating doctor certifying that the worker is fit to undertake all aspects of the proposed training should accompany the request.  The request should be in writing and the worker should ask the case manager to respond to the request in writing.

 

If a case manager refuses to approve a request for retraining whether the request came through the rehabilitation consultant or directly from the worker, then the worker has the right to apply to the Workers Compensation Tribunal to review the decision.  The Tribunal will take the principles in WorkCover’s Injury and Case Management Manual into account, but is not bound by them.  Instead, the Tribunal will uphold or set aside the case manager’s refusal depending on whether the refusal is unreasonable in regard to the individual worker.

 

As retraining can mean the difference between a worker obtaining suitable employment or not, it is important that workers diligently pursue a decision from their case manager on a proposal for retraining and then promptly apply to the Tribunal for a review if they disagree with the case manager’s decision.