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Assistance if WorkCover cannot fund your surgery

Not all treatment can be paid for by WorkCover Queensland. We are only able to cover treatment that is considered necessary and reasonable to treat the accepted work-related injury.

Where a claim has been accepted as an aggravation of a pre-existing medical condition, we must consider whether the proposed surgery is to treat the accepted work-related injury or pre-existing condition. We are unable to cover surgery where it is determined that the surgery is to treat an underlying or pre-existing condition.

Some pre-existing conditions may lie dormant for a long time before becoming troublesome. Sometimes a longstanding “wear and tear” problem may be unmasked during the course of work duties or an accident, but sometimes pain may begin as part of a long process for no particular reason.

There are also instances where we may not fund certain surgical procedures which lack satisfactory long term study.

The customer advisor will consider the facts of the case and may obtain further medical opinion before making a decision about approval of treatment. They will talk to the worker and explain their decision.

If we do not approve the surgery requested by a worker’s treating surgeon, other steps that may be available to enable a worker to access further treatment include:

  • talking to their private health insurance provider about whether they can cover the costs of treatment
  • talking to their superannuation fund to see if they have sickness and accident coverage and whether they can cover the cost of the treatment
  • talking to a  doctor about whether treatment is available through a government-funded program
  • talking to a doctor about a referral to a public hospital or other treatment options
  • funding the treatment themselves
  • if your injury was the result of a motor vehicle accident, contacting a Compulsory Third Party insurer.

If unsure why treatment or surgery has not been approved, please call the customer advisor who will explain the decision regarding a worker’s treatment funding. If requested, a letter can be sent explaining why surgery has not been approved.

A worker can also speak to a manager or lodge a complaint through WorkCover’s internal complaints process. If unsatisfied with the outcomes of these steps, a worker has the right to appeal this decision through the Industrial Magistrate’s Court. For further information on this process, please contact your local Magistrate’s Court office.

Last updated
14 June 2019

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