Does WorkCover pay for medication?
The short answer is “yes, if you have an accepted WorkCover claim”. There are of course plenty of exceptions to the answer, which are detailed below, but for the most part, if the medication you are claiming is for the work injury, it will be covered by WorkCover.
Table of Contents
Checklist:
To make sure that you will be paid for your medication, you can follow this checklist as a general guide:
| 1. have an accepted WorkCover claim |
| 2. have an ongoing injury |
| 3. retain the receipts from medication purchases |
| 4. submit the expenses to the WorkCover insurer (not the employer) |
| 5. make sure that you respond to any questionnaires sent to you by the WorkCover insurer about your medical treatment |
Reasons that WorkCover might not be paying for your medication.
There are numerous different reasons why WorkCover might not pay for your medication. Here are the most common reasons:
1. you were already taking this medication prior to your work injury occurring;
2. you/the chemist have not submitted the medical expenses to the WorkCover insurer to pay;
3. WorkCover may have rejected the expense claim on the basis that the receipts or invoices provided to them do not meet the requirements to claim pharmacy expenses;
4. the WorkCover insurer has previously terminated your entitlement to medical and like expenses;
5. the medication that you are taking is not an approved medication with WorkCover;
6. your entitlement to medication is under review.
Your entitlement might have been terminated on the basis that:
1. your injuries are no longer work related;
2. your entitlement to weekly payments was terminated 52+ weeks ago and specific requirements aren’t met (for example, surgery is required or you couldn’t remain at work without the medication).
3. you engaged in serious misconduct.
If your entitlement has been terminated, you can challenge the decision through the conciliation process.
Summary
Make sure to keep receipts for any medication expenses you incur, forward them to your WorkCover insurer (identifying yourself with your name, DOB and claim number) and ensure that what you’re claiming is related to your work injuries. If you can follow these simple steps, you shouldn’t have any issues having your medication expenses covered.
