All about WorkCover medical expenses in Victoria
Can I claim WorkCover medical expenses?
If you have an accepted WorkCover claim, WorkCover Insurer is liable to pay the reasonable cost of medical and like expenses.
This is the case regardless as to whether or not the injury results in time off work.
The expenses covered by WorkCover are set out in the legislation, and cover medical hospital, ambulance, chemist, nursing and travelling expenses, artificial medical aids, and treatment by registered chiropractors and osteopaths.
The insurer can also pay for household and gardening expenses, as well as rehabilitation expenses.
Medical expenses payable by WorkCover without the need for a referral from a medical practitioner:
- Attendant care
- Appliances and aids that may assist with mobility etc
- Car modifications
- Elective surgery
- Equipment – which includes equipment hire
- Hearing aids
- Home exercise equipment
- Modifications to the home (eg; railing, removal of steps and installation of ramps)
- Gym or swim programs
- Occupational therapy
- Network psychology
- MRI scans
- Pain management program
The following medical expenses require referral from a medical practitioner:
- Exercise physiology
- Household help
- Grief and loss counselling
- Occupational therapy
- Remedial massage
- Social work
- Speech pathology
The following medical expenses don’t need a referral from a medical practitioner or any prior approval from the insurance company:
- Ambulance expenses
- Chiropractic treatment
- Dental services
- Family counselling
- MRI scan requested by your specialist
- Occupational physiotherapy
- Osteopathy treatment
Will the insurer pay for more than one type of physical treatment?
It’s important that you know that we can only fund one type of physical treatment (physiotherapy, osteopathic or chiropractic) at a time.
Will the WorkCover insurer pay for all of a medical expense?
As with Medicare and Private Health funds, there may be a gap between what we can pay for and what the treatment costs. You can visit the WorkSafe website for a list of scheduled fees.
What if I need modifications to my vehicle?
Yes, the insurer is liable to pay for the cost of any modifications required to a vehicle as a consequence of suffering the injury. If the car is not capable of being modified, then the insurer is required to contribute a reasonable amount to the purchase of a reasonably suitable car.
What if I need modifications to my home?
If you require modifications to a home, the insurer is liable to pay for the reasonable cost of any modifications. If the home cannot be recently modified they are required to contribute a reasonable amount to the per A semi detachable portable unit or the cost of relocating you to another home that is suitable at all that is capable of being modified.
Can I choose what medical practitioners I see?
Yes, you’re entitled to choose the medical and like services provider.
Am I entitled to the payment of travel expenses related to my treatment?
Yes you are entitled to claim reimbursement for the reasonable cost of any travel expenses that relate to the medical treatment that you’ve received.
This includes any attendances at medical examinations, both for treatment purposes in those organised by the insurance company. This also includes attending the medical panel.
Does an impairment claim impact on payment of my WorkCover related medical expenses?
No, settlement of your impairment benefit claim does not have any impact on your entitlement to The payment of medical expenses.
Does settlement of a common law claim have an impact on my medical and like expenses?
No, settlement of your common-law claim does not have any impact on your retirement to the payment of medical and like expenses.
My weekly payments of compensation ceased, does this have an impact on my entitlement to medical and like expenses?
If weekly payments are payable and this entitlement to weekly payment then ceases, then in general any entitlement to medical Mike ceased at expenses ceases 52 weeks after.
However certain exclusions apply.
Entitlement to the payment of medical like like services does not cease if:
You return to work but you could not remain at work if a particular service was not provided to you.
Also if surgery is required or if you have a serious injury.
Likewise, the entitlement to the payment of medical and like expenses continues if you require modification of a prosthesis or that the service provided is essential to ensuring your health or ability to undertake the necessary activities of daily living does not deteriorate significantly.
How do I claim reimbursement for a WorkCover medical expense?
You need to make sure that you obtain receipts for every expense you would like to claim. Submit all receipts to the insurance company, ensuring to list your name and claim number on all documents. The insurer can pay you directly.
The alternative is to ask the provider to send your bill to the insurer directly to ensure you’re not our of pocket. Ensure to provide the provider with your claim number.
You should keep a record of all receipts.
What if the insurer refuses to pay for a medical expense?
You can appeal their decision to refuse to pay for a medical expense to conciliation. If the matter doesn’t resolve at conciliation, you can proceed to the medical panel or to the magistrates court.