EXAMPLES OF GOOD AND POOR PRACTICE RELATING TO THE PROVISON OF INFORMATION

Examples observed of best practice case management included:

• frequent, extensive and ongoing information provision;

• provision of information in a language that the claimant could understand;

• check lists and documents in the file to monitor information provision; and

• evidence that claimant knew Major Injury Division’s role well. Aspects that undermined best practice case management included:

• delays in provision of information to claimant or family, or no information provided during hospitalisation;

• failure to account for cognitive dysfunction and ability to understand/remember information;

• provision of too much information immediately after hospital discharge when claimant and family were not able to comprehend its meaning; and

• the provision of incorrect or partially correct information to a claimant.

Claimant and service provider comments

5.36 In contrast to the good results from our assessment of the case files, claimants considered that the provision of information was an area in which the Commission needed to improve. While the introduction of the information folder (TACinfo) was well received and actively utilised, not all claimants acknowledged having received a copy, or even the complete set of the fact sheets that accompanied the information folder.

5.37 Many claimants were frustrated that the Commission did not provide clear and specific information about their benefits and entitlements. Numerous claimants, and some carers, indicated that they were “…only made aware of benefits that could have assisted them after they needed them”. Examples of such benefits included attendant care services, respite care and payments to parents who provide care services for the claimant.

5.38 Service providers, claimants and carers complained that information about claimant entitlements and benefits and approvals to acquire services, tended to be verbal and non- specific. Claimants in particular felt that support co-ordinators were often unable to respond directly to their requests about eligibility for services and, at times, provided verbal approval but subsequently withdrew that approval following discussions with their manager. In some cases, benefits were provided late or not at all, and claimants subsequently become aware of their potential eligibility (either via a support co-ordinator, a service provider or comparison with another like claimant). This was mentioned by some long-term claimants and had been the cause of ongoing conflict between the support co-ordinator, the claimant and family members. Some felt resentment and perceived that the Commission was deliberately withholding information, as illustrated in the following case.

“I feel as though they withhold information, as they are worried that people are going to claim too much.” - 63 year old woman with moderate ABI.

MAXIMISING CLAIMANT OUTCOMES

5.39 Several claimants also commented that the Commission did not provide specific reasons for disallowing them access to services. These services included tutoring, provision of internet services and parents acting as carers.

5.40 Few claimants we interviewed could recall receiving any information at the time of hospitalisation or that it was given to family members. The emotional demands placed upon claimants and their carers post-injury and very early in the recovery period may, to some extent, account for this situation. Service providers considered that information provision at this “very emotional time” might be considered information overload and of very little value. Service providers also considered there was a need for support co-ordinators to “follow-up” the information provided to the claimants to ensure appropriate tailoring of information to the needs of individual claimants.

5.41 Although only a small percentage of case files (2 per cent) were assessed as inadequate in terms of the provision of case management information, it would appear that information is not always being communicated and understood by claimants. Many claimants commented that they were not informed of their entitlements or the Commission’s processes of making decisions in relation to eligibility for potential benefits. Claimants or carers might be reaching inaccurate conclusions or perceptions about the Commission, and, in turn, confusion, ill feeling, or conflict may occur between the Commission and claimants.

RESPONSE provided by Managing Director, Transport Accident Commission

The Transport Accident Commission, through focus groups and regular surveys, is continually monitoring the needs of claimants regarding the style and content of its communication. The TACinfo pack is being updated with a new version of the pack expected later this year.

Identification and documentation of risks, needs, abilities and aspirations

5.42 In order to undertake effective case management, the Commission must understand what is required by each claimant at different times. Accordingly, we examined the Commission’s management in relation to the identification and documentation of a claimant’s risks, needs, abilities and aspirations. Specifically, we looked for evidence of:

• appropriate and timely documentation; and

• identification of gaps in documentation and addressing these in an appropriate and timely manner.

5.43 We concluded that 91 per cent of case files received adequate (77 per cent) or best practice case management (14 per cent) in relation to these elements. Importantly, 9 per cent of cases (12 files) received less than adequate case management practice. This was one of the highest levels of less than adequate practice across the 8 determinants of best practice case management. In these cases, limited attention was given to the claimants’ emotional status, behavioural function, social support networks, cognitive functioning and development, medical status and avocational functioning.

MAXIMISING CLAIMANT OUTCOMES

Management of major injury claims by the Transport Accident Commission 61

Examples of good and poor practice

5.44 Table 5E shows examples of good and poor practice in relation to the identification and documentation of claimant information critical to the claimant’s management.

TABLE 5E

EXAMPLES OF GOOD AND POOR PRACTICE RELATING TO THE IDENTIFICATION AND