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In 2002 the Victorian Workcover
Authority (VWA) introduced a new claims management model as part of
a wider reform program to improve its performance in core business
areas. The new model aimed to improve return to work (RTW)
outcomes, achieve cost-effective claims management, and to enhance
the overall effectiveness of case, injury and medical management.
Under the model, claims are triaged and segmented according to
risk, where low-risk claims are handled quickly and high-risk
claims are actively managed.
The objective of the audit was to
assess the effectiveness and efficiency of claims management by
VWA. The audit examined the policies, procedures and activities of
VWA and its six agents, with a particular emphasis on the
arrangements for managing high risk claims, and whether:
- the management of claims
is maximising both outcomes for injured workers and the financial
sustainability of the scheme
- agents are managing
high-risk claims in accordance with VWA’s claims management
model
- VWA’s arrangements
for monitoring and improving performance of claims management are
effective.
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