Treatment entitlements for the injured worker

Treatment entitlements

Entitlement limits

Timeframes

Treatment entitlements

When the claims service provider is determining whether the treatment is considered reasonably necessary, there are certain conditions that need to be met. The treatment or service must:

• take place while the injured worker is entitled to receive compensation (the compensation period) for medical, hospital and rehabilitation expenses
• be reasonably necessary because of the injury
• be pre-approved by the claims service provider (unless the treatment or service is exempt from pre-approval).

Entitlement limits

In the 'Provisional Payments' and 'Reasonable Excuse' period, there is a treatment and services limit of $10,000.

Timeframes

Medical and related expenses will cease at different times depending on the level of impairment and the date your employee ceased to be entitled to weekly benefits.

Entitlement periods for medical treatment and rehabilitation

If an injured worker becomes entitled to weekly benefits after their medical benefits have ceased then their medical benefits may become payable again. This would only apply to a period where weekly benefits are payable.

These timeframes may not apply to the provision of artificial aids, modification of a injured worker's home or secondary surgery.

Please note if your worker is an exempt worker (police officer, paramedic, firefighter) there is no time limit for reasonably necessary medical treatment.