If my claim is accepted, what’s covered?
WorkCover will pay your injury-related medical and rehabilitation costs as long as they’re considered reasonable and medically necessary. This includes things like:
- treatment by a registered medical or allied health practitioner (doctor, physiotherapist, dentist, etc.)
- any medical items that are needed as you recover, like dressings and medicines
- hire of equipment like crutches and wheelchairs
- return to work services that support your recovery
- travel expenses related to your treatment.
How much is covered?
Most medical, hospital or rehabilitation treatments you might need for your injury have set fees. We’ll only pay up to the listed amount. You can find these costs outlined on the Medical Table of Costs and the Allied Health Table of Costs.
If your doctor or allied health provider charges more than what’s listed, you’ll need to pay the difference (gap) yourself.
Will WorkCover pay me or my health provider?
Usually your doctor or physio (or other provider) will send an invoice to us and we’ll pay them on your behalf.
Sometimes they might want you to pay at the time of your treatment. If this happens, we’ll reimburse you as long as your claim has been accepted, the costs are related to your injury and are up to the amount listed in the table of costs.
How do I get reimbursed?
You’ll need to provide us with your bank details (if you haven't already done this) and keep your original receipts. Write your name and claim number on the receipts and send them to us by:
What about hospital costs?
Private hospital fees may be covered by WorkCover as follows:
Non-elective hospitalisation is when you must have certain treatment. This could be due to serious or life-threatening injuries.
We may cover the costs for up to four days, or more than four days if it’s been agreed between your doctor and WorkCover. It needs to have been agreed to before you’re hospitalised or before your hospital stay is extended.
Elective hospitalisation is when the treatment or procedure is one you and your doctor have decided is appropriate for treatment of your injury.
We’ll only cover elective treatment when it’s been agreed to between you and WorkCover before you go into hospital.
What’s not covered?
- any treatments by non-registered practitioners. These include most alternative medicine treatments like massage and acupuncture (unless they’re provided by someone like a doctor or physiotherapist or registered Chinese Medicine practitioner).
- some travel expenses
- hospital costs that have not been authorised.
What if you can’t cover my costs?
There are a number of reasons we might not be able to pay for your treatment or surgery. This could be related to pre-existing conditions or other reasons. WorkCover will explain why, if this is the case.
If we don’t accept your claim, you’ll be responsible for paying your medical and rehabilitation costs. There may be other options available to assist you. Learn more about what happens if a claim is not accepted.
If your employer is self-insured they might do things slightly differently. You’ll need to talk to them directly about your situation.
You can talk to WorkCover on 1300 362 128 if you have any questions about this or need more information about payments and support.