WorkCover provisional payments
if you lodge a WorkCover claim, typically, you are not entitled to receive benefits until the claim has been accepted by the WorkCover.
However, if you have a claim that involves a psychological injury, you will have an entitlement to the payment of some expenses even if your WorkCover claim is rejected after the claim determination period.
This is called an entitlement to provisional payments and will be explored further on this page.
Table of Contents
What are provisional payments?
Provisional payments refer to the payment of medical and like expenses relating to the treatment of your psychological injury.
The psychological injury should be the injury that you have claimed is related to your employment and is the subject of your WorkCover claim.
You are only entitled to provisional payments if you are claiming a psychological injury.
If the claimed injury is physical only, then you will not have an entitlement to provisional payments and will need to wait until your claim has been accepted in order to obtain the payment of medical and like expenses.
If you have an entitlement to provisional payments, the WorkCover insurer will pay your reasonable medical and like expenses for a period of 13 weeks.
It’s important to note that provision payments involve the payment of medical and like expenses only.
It is not an entitlement to weekly payments or income payments. You are not able to obtain weekly payments from the insurer unless you have had your WorkCover claim accepted.
Why are provisional payments made?
WorkSafe says the following as to why provisional payments are made:
- to help support people with psychological injuries with their recovery and help them return to work.
- designed to help those people with psychological injuries to get early medical support
- gives workers the best chance of recovery.
- early medical support can also help prevent a psychological injury from getting worse.
Provisional payments eligibility
You’ll be entitled to provision payments if:
- You’ve lodged a WorkCover claim
- The injury is a psychological injury
- Your employment is connected to Victoria
- No previous claim has been accepted for the same injury and circumstances of injury.
What expenses will be paid for?
Just as you need to do in order to claim medical and like expenses once a WorkCover claim is accepted, in order to claim provisional payments you’ll only be able to obtain payment provisional payments if the medical and like expenses you are claiming are considered ‘reasonable’ by the insurer.
People with psychological injury may want to claim, for example, psychologist attendances, psychiatrist attendances, GP attendances and medication expenses.
In most instances, generally speaking all of this treatment will be considered reasonable by the WorkCover insurer.
An example of treatment that might not be considered reasonable by the WorkCover insurer would be if you wanted to see your GP or psychologist everyday (generally speaking).
Or if you wanted to claim medical treatment for your psychological injury that is experimental.
What happens if the insurer won’t pay for a medical and like expense during the provisional payments period?
Just as you could do if you had an accepted claim and the insurer refused to pay for a particular medical and like expense, you can contest the decision.
You can ask the insurer to review their decision, and/or you can elect to lodge a conciliation.
What happens with provisional payments if the WorkCover claim is accepted?
If after the WorkCover claim determination period, your claim is accepted for your psychological injury, then you will usually be entitled to continue to receive payment for medical and like expenses.
What happens with provisional payments if the WorkCover claim is rejected?
If after the claim determination period, your claim is rejected for your psychological injury, then this usually should have no bearing on the payment of the 13 weeks of provisional payments.
You will be entitled to the full 13 weeks of payments if, for example, the claim was rejected after four weeks of you receiving payments for medical like expenses. You would be entitled to the remainder of the 13 weeks.
You would not be required to pay any treatment expenses back if your claim is later rejected.
Conclusion
Provisional payments is an entitlement that you will have if you lodge a WorkCover claim that is for a psychological injury.
It means that the WorkCover insurer will pay for your medical and like expenses for a period of 13 weeks.
Any medical and like expenses claimed need to be considered ‘reasonable’.
This entitlement to provisional payments exists regardless as to whether your WorkCover claim is later rejected or accepted.
