Medical treatment and rehabilitation for workplace injuries

If you have an eligible workers compensation claim, you may be able to have the costs of your medical treatment paid for by us.

This can include treatment in a public or private hospital, ambulance services, doctor’s appointments, physiotherapy and rehabilitation. 

Because we are bound by NSW legislation, we are only able to provide care or compensation in certain circumstances.

What you are eligible to receive depends on your specific case and which legislation applies to you.

To be eligible to receive medical and related treatment, hospital treatment and rehabilitation services, the injury must be reported to start the claim process.

Start the claims process

 

Entitlement periods

You can claim for the cost of medical and related treatment, hospital treatment and rehabilitation services related to your injury. Generally, we will pay the hospital or service provider directly so you are not out of pocket. If you require extended treatment for your injury, some limitations apply. For some treatment, you will need to obtain pre-approval from your insurer.

The period that we can pay for medical and related treatment depends on how serious your injury is and whether you have a permanent impairment. Permanent impairment is determined by a medical specialist with appropriate training and accreditation from SIRA.

 

Workers with no permanent impairment or permanent impairment from 1 to 10 per cent can claim:

  • from the date of claim to two years after weekly payments stop being payable, or
  • for two years from the date of claim if no weekly payments made.

 

Workers with permanent impairment from 11 to 20 per cent can claim:

  • from the date of claim to five years after weekly payments stop being payable, or
  • for 5 years from the date of claim if no weekly payments made.

 

Workers with high needs can claim expenses for life. This refers to workers:

  • with a permanent impairment assessed as greater than 20 per cent or
  • where an approved medical specialist has declined to make an assessment the worker has not reached maximum medical improvement or
  • for whom the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent.

 

What we can pay for

As a workers insurance provider, we can pay for medical and related treatment, hospital treatment and rehabilitation services that are deemed reasonably necessary and required as a result of your injury. Before approving or paying for treatment, the insurer must decide whether the service is reasonably necessary and required as a result of the work injury or illness.

This includes things like:

  • Treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists, other allied health practitioners
  • Hospital treatment in a public or private hospital
  • Emergency, non-emergency and inter-hospital transfers provided by the Ambulance Service of NSW
  • Provision of equipment and artificial aids
  • Attendant care and domestic assistance services
  • Nursing, medical and medicine supplies (provided outside of hospital treatment)
  • Modifications to your home or vehicle

Most treatment requires prior approval, however, some treatments do not require it.

The SIRA Guidelines for claiming workers compensation provide the full details of treatment exempt from prior approval.

 

Treatments and services that may not require prior approval include:

  • Treatment provided within the first 48 hours following the injury
  • Consultation with the nominated treating doctor
  • Services provided in an emergency department of a public hospital for injury
  • Some diagnostic investigations within a certain period from the date of injury
  • Some pharmaceutical items prescribed by the nominated treating doctor or medical specialist
  • Up to 8 consultations for physiotherapy, osteopathy or chiropractic treatment
  • Up to 8 psychological treatment or counselling.

Generally, all other treatment and related services requires pre-approval. You should speak with the person managing your claim for more information on the process for obtaining approval. Normally this simply means your doctor or treatment provider needs to send a written request for approval. A decision on treatment must be made within 21 days of receiving the request.

 

Workplace rehabilitation services we may be able to provide include things like:

  • Return to work and case management
  • Vocational, functional and workplace assessments
  • Job analysis and modification
  • Identification of suitable employment
  • Worker retraining and placement in suitable employment.

These services are provided by approved workplace rehabilitation providers.

 

Hospital Treatment

Hospital treatment includes treatment at public and private hospitals and/or rehabilitation centres.

 

Ambulance Services

Ambulance services include emergency, non-emergency and inter-hospital transfers provided by the Ambulance Service of NSW.

 

Travel expenses

If you wish to claim for reimbursement of travel expenses to attend medical, hospital and rehabilitation appointments, you will need to keep:

  • record of mileage if you used your car
  • receipts for public transport.

The maximum amount payable for private car travel associated with attending medical, hospital and rehabilitation appointments is currently $0.55 per kilometre. This amount is reviewed by SIRA every 12 months.

How to request medical and related treatment

Most medical treatment needs to be pre-approved by us as the insurer. For medical treatment to be paid for under workers compensation, it needs to be assessed as reasonably necessary to your injury.

In some circumstances, pre-approval is not mandatory. Examples include:

  • Exempt workers (police officers, paramedics and firefighters, coal miners, rescue and emergency service workers and workers suffering from a compensable dust disease)
  • Treatment provided within the first 48 hours following the injury
  • Consultation with a nominated treating doctor
  • Services provided in an emergency department of a public hospital for injury
  • Some diagnostic investigations within a certain period from the date of injury
  • Some pharmaceutical items prescribed by the nominated treating doctor or medical specialist
  • Some consultations for physiotherapy, osteopathy or chiropractic treatment
  • Some psychological treatment or counselling

If you have a severe workplace injury and you’re in the Workers Care program, talk to your icare coordinator to request medical and rehabilitation services. 

Workers Care eligibility