Medical, hospital and rehabilitation

We can pay for medical treatment for people who are injured or unwell due to a work-related injury (including various dust diseases) or motor accident in NSW.

If you have an eligible workers compensation claim, or you’ve been accepted into one of our care schemes, you may be able to have the costs of your medical treatment paid for by us.

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

We are able to provide the costs of medical treatment if:

  • You sustain an injury at work
  • You develop a compensable work-related dust disease that results in a disability
  • You are severely injured in a motor accident

Because we are bound by State Government Acts, 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.

Medical costs must be reasonably necessary, or reasonable and necessary in the case of icare lifetime care participants, and arise as a result of your injury for us to be able to pay for it.

    Workplace injuries

  • Who is eligible

    If you have a compensable work-related injury, you may be able to have your medical and related treatment, hospital treatment and rehabilitation costs paid for by us.

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

    Make a claim
  • Entitlement periods

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

    These may 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
    • some consultations for physiotherapy, osteopathy or chiropractic treatment
    • some psychological treatment or counselling.

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

    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.

    Workplace rehabilitation services include:

    • 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.

    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.

    When will your expenses be paid for:

    You may only claim for the cost of medical and related treatment, hospital treatment and rehabilitation services during a specific compensation entitlement period.

    The compensation period that applies to you depends on whether or not your injury has resulted in an assessed degree of permanent impairment.

    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.

    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
  • How to request medical and related treatment

    Most medical treatment needs to be pre-approved by us as the insurer. For a 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.
  • Work rehabilitation services

    These services are provided by approved workplace rehabilitation providers and include:

    • 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

    Dust diseases

  • Who is eligible

    If you receive compensation through Dust Diseases Care, you are also entitled to medical treatment and care.

    To be eligible to receive any of these services, you will need to have your care needs assessed by an occupational therapist or another medical professional such as Registered Nurse.

  • What we can pay for

    We can pay for treatment costs that are reasonably necessary and are required as a result of your dust disease. 

    This includes things like:

    • Doctor's appointments and medication, including home-based oxygen and nebulisers
    • Travel to and from your doctors’ appointments
    • Treatment for your dust disease in a hospital or nursing home, or in palliative care or a rehabilitation centre
    • Therapeutic treatments like exercise and massage
    • Respite care (out of home) or rehabilitation centre admissions
  • What we can't pay for

    There are some situations where we may not be able to pay for your treatment costs under the workers compensation legislation.

    For example, this includes:

    • Treatment or medical costs that are related to another disease or condition
    • Federal Government Accommodation Bonds to enter a nursing home
    • Food, vitamins or supplements, unless prescribed as part of a treatment regime relating to your dust disease
    • Medical treatment or medicines received while visiting or living overseas
    • Home renovations or painting