Does WorkCover cover ambulance expenses?
Yes, WorkCover will in most instances cover the cost of ambulance expenses.
This is provided that you have an accepted WorkCover claim, and that the ambulance expenses relate to your work related injury, illness or condition.
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WorkCover will pay for the cost of ambulance expenses if you have an accepted claim
The WorkCover insurer will cover ambulance expenses if you have an accepted WorkCover claim.
This means that you’ve completed, signed and lodged the WorkCover claim form.
Sometimes, people believe they have lodged a WorkCover claim when in reality they haven’t.
Just obtaining a WorkCover certificate of capacity, for example, does not mean you have a WorkCover claim.
If you submit an invoice relating to ambulance expenses to the WorkCover insurer without having an accepted WorkCover claim, they will likely not cover the expenses.
When are ambulance expenses covered?
If you have an accepted WorkCover claim, ambulance expenses will be covered if the need for the ambulance service was for the purpose of receiving medical or hospital services, or to transfer you to your place of residence after receiving medical or hospital services.
You are not able to just submit ambulance related expenses to the WorkCover insurer and have them cover the cost of the expenses without first having a WorkCover claim accepted.
If you have an accepted claim when the ambulance service is required, and if you’re able to, you could give your claim number to the ambulance/hospital and ask them to send the relevant account to the WorkCover insurer directly.
Alternatively, if they send the bill to you then you can forward the bill to the insurer when you’re able to, making sure to refer to your claim number.
If you don’t have an accepted claim when the ambulance service is required, a WorkCover claim should be lodged when appropriate.
What ambulance expenses are covered?
The ‘reasonable costs’ of ambulance expenses are covered.
This means that in most instances, the full cost of ambulance services required should be covered by the WorkCover insurer.
Is there a cap on how much the insurer will pay for ambulance expenses?
There is no cap, but what the insurer considers when paying for ambulance expenses is whether an ambulance expense is reasonable.
What if the insurer refuses to pay for the costs of ambulance related expenses?
If you have an accepted WorkCover claim, the insurer should send you a letter advising as to why they will not cover the cost of the ambulance related expenses.
Is it because they don’t believe it’s related to your work related injury, illness or condition?
Or is it for another reason?
Whatever the reason, the insurer should advise you of it.
If you believe the insurer has made an incorrect decision, there’s a couple of options open to you.
You can ask the WorkCover insurer to perform an internal review. This means that someone from the insurer, who was not responsible for making the original decision, would be required to review the decision to not cover the full cost of the ambulance service.
In addition to this, you can lodge a conciliation request form which initiates the conciliation process.
You’re able to handle the conciliation yourself, or you can engage a representative in the form of a lawyer or WorkCover assist.
What if the entire cost of ambulance expenses are not covered by the insurer?
As mentioned above, you can ask the insurer to perform an internal review to reconsider the matter.
In addition to this (or alternatively), you can request a conciliation.
Do you have ambulance cover?
If you have ambulance cover which many people do, remember that this can be used to cover the full cost of ambulance expenses rather than having the WorkCover insurer pay.
In most instances, the WorkCover insurer will cover the reasonable costs of ambulance services that relate to the treatment of your work related injury, illness or condition.
This is provided that you have an accepted WorkCover claim and the need for the ambulance service was for the purpose of receiving medical or hospital services, or to transfer you to your place of residence after receiving medical or hospital services.