What medical treatment is covered under WorkCover?

What medical treatment is paid under WorkCover?
  • You are entitled to receive medical treatment from the medical practitioner of your choice. You are not obliged to obtain treatment from your employer's doctor. Your employer's doctor can of course often provide good treatment particularly in emergencies, but some workers choose to obtain treatment from their own doctors. For major procedures, prior approval from WorkCover is necessary, unless the treatment is urgent.

  • All routine medical treatment for your injury is paid by WorkCover. This includes the costs of hospitals, specialists, scans, physiotherapists, chiropractors, chemists etc. If surgery is also required because of your injury, its cost is covered.

  • In some circumstances WorkCover will also cover the costs of home help, including gardening.

  • WorkCover also covers the cost of gymnasium or swimming if approved by your doctor and if it is necessary to improve or maintain your condition.
Medical treatment costs remain payable after you return to work, or after your weekly payments cease if the treatment is necessary to ensure that your health or your ability to undertake activities of daily living does not deteriorate.

WorkCover has terminated my medical treatment, what should I do?
It is common for WorkCover to terminate or reject medical treatment claims. In fact, WorkCover very closely monitors all medical treatment expenses. The most common expenses that are rejected or terminated relate to long-term physiotherapy or psychological counselling expenses where WorkCover considers that they are not resulting in any therapeutic improvement in your condition.

The most common reasons for a rejection or termination of medical expenses are as follows:
  • WorkCover medical advisers have indicated to WorkCover that the treatment is unnecessary.

  • WorkCover considers the treatment is no longer is effective or can be replaced by self managed home exercises.

  • Weekly payments have ceased more than 52 weeks ago (click here for more information).
If WorkCover advise you that they intend to terminate your medical treatment expenses, you should refer the dispute to the Accident Compensation Conciliation Service for resolution of the dispute. One of the most common methods of resolving this type of dispute is to refer the issue to the Medical Panel. When a matter is referred to the Medical Panel, it is often important to be in a position to demonstrate that in the absence of treatment, your condition will worsen. It can sometimes be useful to have a discussion with your treating doctor about whether you should have a brief break in your treatment, particularly physiotherapy treatment to determine the effect of its termination on you.

If your treatment expenses are not restored through conciliation or through a decision of the Medical Panel, it does not mean that your entitlements are finalised for good. If you can demonstrate at a later time that your condition has become worse, making the treatment essential, it is possible to reapply for medical expenses.

Print