Published: 04 December 2018
Author: Stringer Clark

Top 10 questions about WorkCover and medical services

We are always happy to answer questions from injured workers about accessing medical and like services under WorkCover. Some of our most frequently asked questions follow.

1. What treatment can I get for my injuries?

You can claim the ‘reasonable costs’ of services that are necessary to treat your work injuries. You can also claim travel costs to attend medical appointments and request help around the house and in the garden, and other ‘like’ services.

2. When do I need a referral to get treatment?

Services for which you will need a referral and pre-approval from your WorkCover agent include surgery, household help, gardening, chiropractic treatment, remedial massage and psychology. Always check if a service requires pre-approval before getting treatment.

3. Do I have to see the company doctor?

No, not if you don’t want to. Under WorkCover, you are entitled to choose your own providers, even if your employer offers or provides the same service. Your provider must be registered with WorkSafe for the agent to pay for the service.

4. Why is there a gap payment?

The agent will only pay the ‘reasonable costs’ of the service. WorkSafe publishes the maximum payment rates for services on the WorkSafe website. To avoid bill shock, ask your provider upfront about fees and whether they intend to charge a gap payment.

5. Why won’t the agent pay for my physiotherapy anymore?

The agent will only pay for ongoing treatment if it is helping you to get back to work, or stay at work, or is necessary for you to complete daily living tasks, and the costs are reasonable.

If you disagree with the termination of a service, you can have the matter reviewed via the Accident Compensation Conciliation Service. Requests for conciliation must usually be made within 60 days of the decision.

6. Why won’t the insurer pay for my massage therapy?

The answer could be because your therapist isn’t registered with Worksafe and is not a member or eligible for membership with a recognised professional massage therapy association. The agent will only pay for remedial massage services and probably not aromatherapy massage or hot stones. Remedial massage also usually requires pre-approval.

7. Why won’t the insurer pay my old medical receipts?

Medical expenses must be claimed within six months of receiving treatment or the agent can refuse to reimburse you.

8. Why have my medical and like services been terminated?

A worker’s entitlement to compensation for most medical and like services, not including surgery and prosthetics, ordinarily ceases 12 months after weekly payments are terminated. This is unless you are receiving a service that enables you to keep working or is essential to your health or daily living. Services may be terminated sooner for other reasons. For example, if the service is no longer considered reasonable, or if you have recovered from your injuries. Again, if you disagree with a termination decision, you can request that it be reviewed at conciliation.

9. What happens to my medical and like services after my common law claim?

It is not possible to receive a lump sum for your future medical expenses if you have a common law claim. Your entitlement to medical and like services continues after the conclusion of your common law claim, subject to it being found reasonable to treat your injuries.

10. Will the agent pay for firewood?

The agent can pay for firewood if, before you were injured, you used to gather, chop and stack the wood, and you only used firewood for heating and/or cooking, and no one else at home can help with the wood. There are limits on how much wood you can receive and for how long.