Does WorkCover pay for doctors?

TL;DR

 

If you have an accepted WorkCover claim, you’re entitled to be paid for the costs of reasonable medical and like expenses. Part of this includes having your doctors bills paid for. WorkCover will pay for doctors bills that they deem to be ‘reasonable’ in the circumstances.

For example, if you have a work related injury and you want to see your GP once every couple of weeks or once a month for treatment then depending upon the nature of the injury, this would usually be fine and you will likely have no problems obtaining payment for your doctors bills.

However, let’s say that you want to see your doctor once every few days and you have what could be classed as a minor injury. In this instance the insurer will probably not pay for these attendances.

So it’s all about what is reasonable.

The insurer in some cases might obtain medical material from your doctor or other doctors to help them determine whether the expense is reasonable in the circumstances.

In addition to paying for GP visits, the WorkCover insurer can also pay for you to see other doctors.

For example, you may need to see a specialist such as an orthopaedic surgeon.

Again, if the expense is deemed reasonable, the insurer will pay for it.

If you need things such as surgery or more in-depth medical treatment provided by these doctors, then in many cases the WorkCover insurer can cover these expenses also.

What the insurer will cover or reimburse is based on WorkSafe’s scheduled fees.

How to obtain payment for doctors bills:

In order to claim payment, there are two general ways that you can go about it.

The first is that you pay for the expense yourself and then submit your accounts to the insurance company for payment.

They will then be required to pay you directly.

The second way is that you ask your doctors to send off any accounts directly to the WorkCover insurer for payment. You must provide your doctor with the details of the WorkCover insurer and importantly, your claim number.

If your doctors bills are not being paid for, and you believe the expense is reasonable and should be paid for, then you can pursue a conciliation. You can read more about the conciliation process here.