Case management guidelines
These guidelines should be read in conjunction with our General provider guidelines.
Who can provide case management services?
You can provide services if you are a case management provider, and:
- you are registered with us to deliver case management services
- you have a professional qualification aligned with expertise in the provision of case management services, such as a social worker, psychologist or allied health professional
What we can pay for
We can pay the reasonable costs of case management for our clients when prior approval has been given.
We can approve the provision of reasonable, strengths-based case management services for a client who has a disability as a result of transport accident injuries, and requires the specific expertise of a case manager. Case managers may assist with:
- Finding sustainable accommodation.
- Supporting our client to make informed decisions and exercise choice and control in their lives – where necessary utilising a supported decision making framework.
- Facilitating transition planning, such as from a secure environment into the community.
- Overseeing and 'walking' the client through complex legal matters, such as custodial issues or criminal charges. Legal matters must not relate to legal disputes with us.
- Supporting our client to re-establish their role in the community, at home, in school, at work and in leisure activities.
- Supporting our client in their reunification with significant others.
- Supporting our client in specific matters which require advocacy, utilising both a supported advocacy framework and building self-advocacy skills, such as access to mainstream services.
- Proactive contingency planning and, where necessary, crisis intervention.
We require that case management providers comply with reporting requirements. These are based on measuring:
- access (i.e. prompt access to the service)
- service quality (i.e. client outcomes)
We also require client progress reports for each client at three-month intervals. These reports must include the following, at a minimum:
- progress of client outcomes, such as the independence goals and evidence to support this
- risk management and evidence to support this
- crisis management and evidence to support this
Other things to note
Case managers do not have any delegation of power under the Transport Accident Act 1986 to approve services that we pay for.
All services recommended by case managers require prior approval in writing by a TAC coordinator.
What we cannot pay for
We will not approve the provision of case management services:
- For a person other than the injured client.
- That are not required as a result of transport accident injuries.
- If relevant services are already being provided by another provider involved in the client's care.
- When the case manager is acting in the capacity of guardian, administrator or attorney, or is signatory to any of these for the client.
- When the case manager assists with the making of decisions on behalf of our client, our client’s administrator or guardian or by the client's family.
- To coordinate and facilitate legal processes for a client in order to review decisions made by us.
- That are hospital services, medical services, Authorised Rehabilitation Services or Authorised Disability Services, other than approved case management services.
- Not payable under the Transport Accident Act 1986.
- Received by the injured person outside the Commonwealth of Australia.
- Provided more than two years prior to the request for funding, except where the request for payment is made within three years of the transport accident. See the Time Limit to Apply for the Payment of Medical and Like Expenses policy.