Hand therapists assess, diagnose and treat injuries and conditions of the fingers, hands, wrists, elbows, and shoulders within the scope of their individual practice.  Hand therapy helps patients return to optimal function after trauma or surgery.

This policy applies to occupational therapists and physiotherapists who deliver hand therapy.

The TAC can pay the reasonable cost of hand therapy provided to a TAC client by a hand therapist which is required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of hand therapy. This includes:

• Hand therapy assessment and intervention to:
  • assess and diagnose upper limb injuries
  • develop treatment plans and review progress using outcome measures
  • conduct psychosocial screening
  • provide education, manual therapy, wound and scar management and exercise-based treatment
  • identify and achieve client goals such as return to work, social or domestic activities
  • assess and provide custom-made orthoses (splints)
  • prescribe equipment or aids
  • complete and issue Certificates of Capacity for TAC clients.
• Splint fabrication as part of the consult; extended consultations should not be charged except for complex splint fabrication (to be pre-approved by the TAC).
• Extended consultations for treatment that cannot be adequately addressed in a standard consultation for a client who has complex injuries such as significant brain injury, spinal cord injury, crush injury or burns.
• Equipment prescription, including splints, in accordance with the Medical and rehabilitation equipment policy.
• Completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC can pay for a hand therapist’s travel to and from a client, where reasonable and clinically justified. This must be pre-approved by the TAC. Travel time is paid between the hand therapist’s practice address and client's residence.

The TAC will pay for treatment and services according to the hand therapy fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

• Services that are not required for the treatment of transport accident-related injuries
• Services provided by individuals who do not meet the hand therapy policy requirements or comply with the Allied Health Policy
• Services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• hand therapy services provided by students or by practitioners who are not registered with AHPRA.

Within the first 90 days of a client’s accident, the TAC can help pay for hand therapy without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.

If a hand therapist intends to continue treating a TAC client beyond 90 days after their transport accident, they will need to send a request in writing using the relevant TAC template. The TAC will review a client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. The TAC will assess the request and let the hand therapist and the client know the decision about what the TAC can help pay for and for how long.

If a client has not received treatment in 6 months they will need to seek approval from the TAC before the TAC will pay for further treatment. Hand therapists should ask their client for a copy of their approval if they haven’t seen the client in 6 months.

Hand therapists must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded hand therapy, a hand therapist must:

• Be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the occupational therapy or physiotherapy professions (other than as a student)
• Comply with the TAC Allied Health policy.
• Adhere to the principles of the Clinical Framework for the Delivery of Health Services
• Operate within their individual scope of practice or refer onto a more suitable practitioner where appropriate

Promoting independence and avoiding treatment dependence
In line with Principle 3 of the Clinical Framework, the TAC expects that hand therapists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available on the TAC website.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to hand therapy services if the TAC has accepted liability for the accident-related injury that relates to the hand therapy service.

2. Reasonable

When deciding if hand therapy is reasonable, the TAC considers whether the cost of the service is reasonable in relation to the Hand Therapy fee schedule. The TAC will also assess whether the cost of any splints or prescribed equipment is reasonable in line with the Medical and rehabilitation equipment policy.

3. Clinical Justification:

When deciding if hand therapy is clinically justified, the TAC considers whether:

• hand therapy is clinically appropriate for the client’s transport accident injuries and presentation
• the treatment complies with the principles of the Clinical Framework (see guidance on clinical best practice in the Allied Health Policy above)
  • treatment should result in a measurable benefit to the injured person
  • the treatment adopts a biopsychosocial approach
  • the treatment empowers the client to self-manage their injury
  • the treater implements goals focused on optimising function, participation and return to work/health
  • the treatment is based on the best available research evidence.
• the duration and frequency of treatment is appropriate in relation to the client’s condition and their recovery progress. These factors are assessed on a case-by-case basis.  Treatment sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Treatment should be discontinued, and the client discharged when either:
  • the client can independently manage their recovery
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatment
  • there is no measurable benefit on outcome measure scores from continued treatment

4. Outcome Focused:

When deciding if hand therapy is outcome focused, the TAC considers whether the service is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

For more information on TAC decision making, see the ‘How we make decisions’ page.