We may ask you for a medical report to help decide or manage a claim. This is so we can learn more about your patient’s work-related injury and current work capacity.
In report requests we'll ask about:
- the 'event' that caused the injury
- previous or similar injuries
- the worker's capacity
- your treatment recommendations
- details of the rehabilitation and return to work plan, including time frames
Make sure you answer all the questions we ask in the report request. This helps our decision-making process, which in turn assists an injured worker’s access to treatment and a timely return to work.
Requested reports are paid for based on the item codes listed in the fee schedule. The amount can vary depending on what we ask for in the report and how quickly it's provided to us.
Please provide your report and invoice to us within 30 days of the examination. Getting us your report as quickly as possible means we can support your recommendations and help your patient faster.
Learn more about how to invoice us.
Privacy and freedom of information
Information you give us becomes part of the claim file, which may be requested and read by other people. This might include claims staff, our network of advisory doctors, specialists at the Medical Assessment Tribunals, or during legal proceedings.
We're also required to release information if it's asked for and required by law (e.g. a freedom of information request). These requests are usually from the worker or an employer.
Release of sensitive information
When information might be harmful to someone’s health or well-being, we release the information to a medical practitioner. After reviewing the supplied information, it's your decision to release, discuss or hold back the information.
We may request a Comprehensive Clinical Report (CCR) from you to make sure we have a full understanding of the diagnosis, treatment and prognosis at the start of the process.
A CCR can reduce the administrative requirements of the claim (e.g. removing the need for ongoing work capacity certificate/s).
We may ask for the report as part of the claims process. Or, if you think it will help our management of the claim you can ask us for pre-approval to submit one.
Pre-approval is not required for a CCR on an accepted and open claim where:
- the initial consult has been undertaken, any imaging has been completed, the full treatment plan is known and surgery is not pending
- it's post-surgery and information has not been covered in a previous CCR.
You must provide your CCR within 20 business days from the initial consultation.
The item codes that you can use for the CCR are:
- 100150 if received within the required timeframes
- 100151 if received outside the timeframe.
Where surgery is requested after the initial consultation, the surgery request form should still be used and the CCR completed within 10 business days post-surgery.
If the treatment plan changes, a progress/short report is all that is required. If there's been a substantial change in treatment, pre-approval isn’t required. The item code for this is 100806.
A CCR is not required, and may not be paid for, if the:
- full treatment plan isn't known
- injury is simple and there's no need for further specialist review
- claim hasn't been accepted, is closing, has stopped or been finalised by permanent impairment.
- diagnosis is unclear due to pending pathology results etc.