Published: 30 April 2019
Author: John Cramp
How can injured workers successfully claim for medical and other expenses?
If injured at work, most people are aware they are entitled to benefits pursuant to the 2013 Workplace Injury Rehabilitation and Compensation Act.
One of the most important entitlements is the reimbursement of reasonable medical and like expenses (section 224). The aim is to ensure that injured workers are not out of pocket for treatment or medication required as a result of their injury.
The method to make sure workers are reimbursed quickly for expenses incurred seems to be unwieldy at best. Increasingly we are contacted by clients experiencing difficulties with their insurer in this area.
In previous times medication reimbursement was simple as the worker would attend their local chemist for medication and the pharmacy would seek the cost of the medication directly from the insurer. Very few pharmacies now offer this method. The reason provided to us is that the insurers were so slow in reimbursing the pharmacies that many simply chose to no longer participate.
Consequently, most injured workers now have to pay up front for their medication and then complete a form that is sent, together with the receipts, to their insurer on a monthly basis. We regularly assist clients who have not been reimbursed promptly. The standard response from the insurer is that they never received the form and to send it again. This results in delays that can have a significant financial impact on the injured worker.
It is imperative that injured workers keep copies of all documents sent to the insurer. We find that email is the quickest and easiest method as there is assurance that the insurer has received the form and receipts or print out from the pharmacy, and you also still have the originals if problems arise at a later date.
Travelling expenses can be significant for rural injured workers as often there are long drives to see specialists located in the major centres. The insurer will reimburse the injured worker at the rate of 30 cents per kilometre, parking fees and meals.
This is a financial burden on the injured worker that needs to be reimbursed quickly. Yet time and again we are contacted by injured workers who have submitted their expenses but have not been reimbursed without numerous phone calls to the claims officer or intervention by their lawyer.
Winter is coming and injured workers can claim the cost of firewood if they previously collected their own firewood but are not able to due to their injury. Like the pharmacy issue above, providers of firewood used to submit their account directly to the insurer.
However, very few operators continue this service due to delays in the payment of accounts. The injured worker must pay for the wood and then seek reimbursement. You must be able to prove you routinely obtained firewood yourself prior to the injury.
Often the insurer will engage a Rehabilitation Consultant to attend the worker’s home to determine whether the wood is required and how much should be provided. If there is a reverse-cycle air conditioner in the home, the consultant will question whether this could be used instead of the open fire. Often an offer to install an air conditioning unit will be made by the insurer. However, the cost of the additional electricity required to run the system is not reimbursed.
There are all sorts of issues that can arise under the heading of “reasonable medical and like services”. Obtaining reimbursement often requires dogged determination by the injured worker. If reimbursement hasn’t occurred after a couple of phone calls to the insurer, contact your lawyer who will make enquiries on your behalf in order to resolve the issue.