Injured Workers Rights to Medical Expenses
Treatment I Personal and household services I Other costs I Time limits I Travel expenses I Extension of payments
Under WorkCover an injured worker is entitled to compensation for the reasonable costs of all expenses including 'medical, hospital, nursing, personal and household, occupational rehabilitation, road accident rescue services and ambulance services received because of the injury'. Your claim must be accepted before the insurer will pay for medical and like expenses.
Many services are available under the heading of medical and like expenses. They must be needed as a result of the work related injury. The main service needed in the first instance is medical treatment. You have the right to choose your own doctors and other treating health practitioners. The only exception to this is with regard to rehabilitation providers. Medical services include treatment by your own General Practitioner, or by doctors at a private or public hospital or appropriate specialists.
TREATMENT
You may require treatment from health professionals other than doctors.
There are a range of approved services for which your doctor can refer you.
These services include the following:
- Acupuncture,
- Dietary analysis,
- Hydrotherapy,
- Massage,
- Naturopathy,
- Occupational therapy,
- Psychology,
- Social work; and
- Speech therapy.
Some health professionals such as dentists, optometrists, physiotherapists, chiropractors, osteopaths or chiropodists must be registered through WorkCover in order to provide services to WorkCover claimants.
PERSONAL AND HOUSEHOLD SERVICES
Personal and household services which are needed to help you to function independently may also be provided by WorkCover. Personal and household services include:
- Aids and appliances;
- Attendant care;
- Car modification;
- Financial counselling;
- Home modifications;
- Household help;
- Nursing services;
- Occupational rehabilitation; and
- Transportation costs.
These services and aids are to help offset the effects of your injury so you can continue daily activity. In order to obtain any of them you will need medical evidence.
OTHER COSTS
The costs of pharmaceuticals needed for treatment are covered under WorkCover, as are prostheses such as glasses, hearing aids and artificial limbs.
The insurer is also liable for the reasonable costs of burial or cremation in the case of death. There is limited counselling available for immediate family members in the case of death of a worker.
TIME LIMITS
If you claim for medical and like expenses only, there is no specified time limit within which the insurer must respond to your claim. Often insurers take a long time before approving medical and like expenses. The WorkCover Authority considers that 60 days is reasonable in the first instance. This may be a major delay if you need urgent treatment. If the insurer has not responded within 28 days it is reasonable to make contact to ask how soon a decision will be made and to request an answer as soon as possible.
You should keep a note in your diary of all contacts with the insurer, including: date and time of contact; person spoken to and position; issues discussed and commitments given.
The key issues leading to disputes about medical expenses are:
Whether the service was necessary or was required so frequently (often disputes are about such things as personal or household services, surgery or the amount of physiotherapy); and Whether the cost was reasonable.
It is important that you obtain support from your treating doctor for any treatment or service which you claim under WorkCover. In order to obtain medical and like services you should give the insurer a written request from your doctor for the approval of services or treatment.
TRAVEL EXPENSES
You are also entitled to reimbursement of reasonable and necessary costs of transport to medical or hospital services but insurers won't pay for a taxi without prior approval and/or if you could reasonably have used public transport or your own car. There are often disputes over travel costs for medical services.
EXTENSION OF PAYMENTS
In most cases you can continue to receive reasonable medical and like expenses for twelve months after weekly payments stop. However this may be extended if:
You have returned to work but, require on-going treatment to keep you at work, you require surgery, or you have a serious injury, orthe service is 'essential to ensuring that the worker's health or lifestyledoes not significantly deteriorate'.
Disputes over medical and like expenses can be taken to conciliation. If you are refused reasonable medical or like services or treatment you should contact your union or Union Assist.
