Medical and rehabilitation expenses
If a claim is accepted, what’s covered?
An insurer will pay a worker’s 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, psychologist, physiotherapist, dentist, chiropractors, Chinese medicine practitioners for acupuncture only, etc.)
- any medical items that are needed during recovery, like dressings and medicines
- hire of equipment like crutches and wheelchairs
- return to work services that support recovery
- travel expenses related to treatment.
Some providers such as massage therapists, naturopaths, myotherapists and acupuncturists who are not Chinese medicine practitioners may not be covered. Insurers can provide more information about what is covered under a claim.
How much is covered?
Most medical, hospital or rehabilitation treatments a worker may need have set fees. An insurer will only pay up to a certain amount, as listed in WorkCover’s Table of Costs. Workers should contact their insurer (WorkCover Queensland or a self-insurer) for more information.
If a doctor or allied health provider charges more than what’s listed, the worker will need to pay the difference (gap).
Will an insurer pay a health provider?
Usually a health provider (a doctor, physiotherapist or other provider) will invoice an insurer directly.
Sometimes a health provider may want a worker to pay at the time of their treatment. If this happens, a worker will be reimbursed by their insurer, as long as the claim has been accepted and the costs are related to the worker’s injury and are up to the amount listed in WorkCover’s Table of Costs.
How does a worker get reimbursed?
A worker needs to provide their insurer with their bank details and keep their original receipts and provide these to their insurer.
What about hospital costs?
Private hospital fees may be covered by an insurer as follows:
Non-elective hospitalisation
Non-elective hospitalisation is when a worker must have certain treatment. This could be due to serious or life-threatening injuries.
An insurer may cover the costs for up to four days, or more than four days if it’s been agreed between a doctor and an insurer. It needs to have been agreed to before a worker is hospitalised or before a hospital stay is extended.
Elective hospitalisation
Elective hospitalisation is when the treatment or procedure is one a worker and their doctor have decided is appropriate for treatment of a worker’s injury.
An insurer will only cover elective treatment when it’s been agreed to between a worker and their insurer before a worker goes into hospital.
MRI scan referrals
Referrals for MRI scans must be completed by a specialist, even in urgent cases.
A GP is only able to provide an MRI referral in specific circumstances. A worker should talk to their doctor and insurer if they’re unsure.
What’s not covered?
- some travel expenses
- hospital costs that have not been authorised.
A worker should try to book any treatment appointments outside of work hours, and speak to their insurer and employer if this is not possible.
What if an insurer can’t cover costs?
There are a number of reasons an insurer may not be able to pay for a worker’s treatment or surgery. This could be related to pre-existing conditions or other reasons. An insurer will explain why, if this is the case.
If an insurer does not accept a claim, a worker will be responsible for paying their own medical and rehabilitation costs. A worker should talk to their insurer directly to understand any options available to assist you. Learn more about what happens if a claim is not accepted.