Medical expenses and other medical-related entitlements

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Medical expenses

Other medical-related entitlements

Medical expenses

Prior to issuing approval for medical, hospital and rehabilitation treatment, your claims service provider (CSP) will assess whether it is related to the injury and is reasonably necessary.

It's important to consider:

• What is reasonably necessary treatment for one worker may not be for another worker with a similar injury
• Reasonably necessary doesn't mean necessary
• If your insurer disputes liability or declines a treatment request based on it not meeting the reasonably necessary criteria, your worker may be personally responsible for payment of accounts.

Learn more about treatment entitlements

Fees

• Fees for medical practitioners are based on the Australian Medical Association (AMA) List of Medical Services and Fees. Other SIRA fees have been agreed with various medical associations to be charged at gazetted rates.
• SIRA approved allied health practitioners (exercise physiologists, chiropractors, counsellors, osteopaths, physiotherapists and psychologists) are bound by the relevant Workers Compensation Fees Orders.

See current health-related fees

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Other medical-related entitlements

Travel Expenses

Your injured worker can claim for travel costs to attend appointments relating to their workplace injury such as medical, hospital and rehabilitation matters.

The maximum amount payable for private motor vehicle transport is $0.55 per kilometre. Your injured worker must keep a record of the kilometres driven or receipts for public transport.

Domestic assistance

Domestic assistance includes support for daily activities that have been impacted by the workplace injury, such as household cleaning, laundry, lawn care and transport (not covered as medical expenses). For domestic assistance to be considered, employees must have completed the domestic tasks prior to their injury.

If a worker requires support in these areas, a medical practitioner (such as an occupational therapist) will assess their current functioning and determine what assistance is required. The medical practitioner must also review whether the request is reasonably necessary.

Domestic assistance is temporary (up to six hours per week for a total period of three months) unless the injured worker has a permanent impairment of at least 15 per cent.

Medication expenses

Injured workers can claim medication expenses if it is directly related to their workplace injury and approved by the insurer depending on whether it meets the reasonably necessary criteria.

The medication must be prescribed by a medical practitioner and supplied by a registered pharmacist. For an injured worker to claim reimbursement, they should provide a dispensary computer-generated tax receipt for claimable medications to the insurer.