Pre-approved treatment
This information applies to claims where provisional liability for medical expenses has been accepted or the claim has been accepted formally.
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Key takeaways
- Whilst most treatment will require pre-approval from your case manager, there are some circumstances that do not require pre-approval.
- Exempt workers (police officer, paramedic, firefighter) do not require pre-approval for any reasonably necessary treatment.
Pre-approved treatment
Whilst most treatment will require pre-approval from your case manager, there are some circumstances that do not require pre-approval.
Even though a formal decision is not required for pre-approved treatment, your case manager will still acknowledge receipt of the treatment request with both you and the provider to avoid any unnecessary delays.
The following circumstances do not require pre-approval from your case manager:
Initial treatment
- Initial treatment within 48 hours of your date of injury.
Nominated Treating Doctor (NTD)
- Consultation (excluding home-visits) or case conferences for your injury: ongoing basis.
- Treatment completed during these consults: within one month of your injury.
Allied health practitioners, such as your psychologist
- Up to eight sessions of pre-approved treatment if the injury has not previously been treated: applicable for treatment that starts within three months of your date of injury.
- Up to three sessions of pre-approved treatment if the injury has not been previously treated: applicable for treatment that starts three months after your date of injury.
- One consultation with a different provider if the injury was previously treated: for example, if you change psychologists, you are entitled to one pre-approved session. Your psychologist will then need to request further sessions from your claims service provider.
- One consultation with the same provider if the provider previously treated the injury more than three months ago.
- Access to reasonable incidental expenses up to $110, such as relaxation CDs or self-help books.
Public hospitals
- Services provided in the emergency department for your injury at any time.
- Services provided after receiving treatment at the emergency department for your injury, within one month of your date of injury.
Medical specialist, such as a psychiatrist
- If referred by your NTD, any consultation and treatment during consultation for your injury within three months of your date of injury.
Pharmacy or medications
- Prescription drugs and over-the-counter pharmacy items prescribed for the injury by your NTD or psychiatrist, within one month of your date of injury.
- Prescription drugs and over-the-counter pharmacy items prescribed for the injury and dispensed through the Pharmaceutical Benefits Scheme (PBS), available on an ongoing basis.
It's important to let your case manager know as soon as possible about any treatment you are having or plan to have to ensure you receive the treatment you require without delay, as generally approval from the insurer is required before medical and treatment services are provided.
Please note: if you an exempt worker (police officer, paramedic, firefighter) you do not require any reasonably necessary treatment to be pre-approved by your case manager.
Even though some treatments do not require pre-approval, it still needs to:
- be due to the result of a work-related injury
- take place whilst you are entitled to receive compensation
- take place whilst you are entitled to receive medical treatment and services (in line with your whole person impairment)
- be reasonably necessary
- be provided by a person who is appropriately qualified.
