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Workcover Medical Expenses

If you have had an injury at work, in accordance with section 60 of the Workers Compensation Act 1987, the worker’s compensation insurer is required to pay all “reasonably necessary” medical expenses.

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Claiming medical expenses can include the below:

1. Medical and related treatment includes:

  • Treatment by medical practitioners, physiotherapist, chiropractors, osteopaths, psychologists, counsellors, exercise psychologists, remedial massage therapists and other allied health practitioners.
  • Provision of artificial aids.
  • Domestic assistance services.
  • Nursing, medical and medicine supplies (provided outside of hospital treatment).

2. Hospital treatment

Hospital treatment includes treatment at public and private hospitals and/or rehabilitation centres.

3. Ambulance service includes emergency, non-emergency and inter hospital transfers provided by the Ambulance Service of NSW.

4. Work place rehabilitation services include:

  • Return to work in case management.
  • Vocational, functional and work place assessments.
  • Job analysis and modification.
  • Identification of suitable employment.
  • Worker retraining and placement in suitable employment.

5. Travel expenses can be claimed. To claim for payment for travel to attend medical, hospital and rehabilitation appointments, the worker will need to keep:

  • A record of the mileage if the worker used his or her car; and/or
  • Receipts for public transport.

The maximum amount payable for private car travel associated with attending medical expenses is currently $0.55 per kilometre.

Would you like assistance with your claim?

Complete our free, no obligation confidential case assessment form and we’ll get back to you within 24 hours.

Alternatively, we are available to talk by phone and email. Please contact our experienced accredited specialist personal injury lawyers to find out how we can help.

No Win No Fee

You won’t be required to pay any fees until we win your case.

Industry Experts

We’re industry experts with over 20 years of experience.

Maximum Compensation

Our team of expert injury lawyers will help you get maximum compensation.

Sam H.
09:47 17 Dec 24
Very knowledgeable, explains everything very clearly and highly recommend.
Rachel R.
09:13 17 Nov 24
Although a long journey, the team at Garling & Co Lawyers have been amazing. They are thorough and clear with the processes and the expectations. It is a pleasure dealing with Emma and Rebecca. They... take all the weight off our shoulders when it comes to all the legal stuff and they make us feel comfortable and confident in their ability to look after us.read more
Angie & Brian M.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more
Yanthi S.
11:22 12 Sep 24
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or told me about the kind of... negotiation in the hearing. I assumed that as a Lawyer she should have an experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Barrister only gave me less than 5 minutes to make decision and pushed me to accept the disappointed outcome and what she said in the hearing totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.As I said before I would not hesitate to let my other claim to be handled by a professional as Matthew Garling. I would like to thank him for his time and effort to settle my case smoothly and I trusted him to give me the best outcome. Also I appreciated his support and his patience to answer my questions from the time I signed the agreement up to the day before the mediation. He did not promise the unrealistic outcome but what ever he promised that what the result was according to his experiences. And I would not forget to Alison, Nathan who also have assisted this matters, by gathering all documents and answering my questions.Also my appreciation to a Barrister Mr Dallas Morgan.So, in summary I am really grateful to have Garling and Co as my lawyer to handle my damaged claim.read more
Tina S
07:45 29 Aug 24
Thank you for the great outcome!
Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more

Find out more about Workers Compensation

Frequently Asked Questions

1. What is “reasonably necessary” medical treatment?

The insurer is required to pay “reasonably necessary” medical expenses. In determining what treatment is reasonably necessary, the insurer should have regard to:

  • The appropriateness of the treatment.
  • The availability of alternative treatment.
  • The cost of the treatment.
  • The actual potential effectiveness of the treatment.
  • The acceptance by medical experts of the treatment as being appropriate and likely to be effect.

The term has also been defined to mean “any necessity for relevant treatment which results from the injury where its purpose and potential effect is to alleviate the consequence of injury”.

Often this test is confused to mean that the treatment must be reasonable and necessary. This is incorrect. That is a much more demanding test.

If the treatment is such that its potential effect is to alleviate the consequence of injury, then it will be “reasonably necessary”

2. Is pre-approval necessary?

Section 60 (2A) of the Workers Compensation Act states that the insurer is not liable to pay for the cost of medical treatment without prior approval of the insurer.

However, there are several exceptions where no prior approval is required and they include the following:

  • Any treatment provided within 48 hours of the injury.
  • Attending a nominating treating doctor for a consultation or to obtain a medical certificate.
  • The first consultation with a specialist medical practitioner on referral by the nominated treating doctor.
  • All plain x-rays performed on referral from a nominated treating doctor or specialist medical practitioner.
  • Any service provided in a public hospital on presentation to an emergency department.
  • In relation to physiotherapy, osteopathic or chiropractic treatment, the initial consultation and up to a further 7 treatment sessions provided the practitioner is registered and the injured worker has not previously received such treatment for the injury claimed.
  • Pharmacy items prescribed by the nominating treating doctor within the first 3 weeks’ post injury up to a maximum of $500.00.
  • For any psychological treatment or counselling, the initial consultation and up to a further 5 treatment or counselling sessions where the counsellor is WorkCover approved and the worker has not previously received such counselling.
  • Payment of up to 5 sessions of remedial massage however the remedial massage therapist must be WorkCover approved.
  • In relation to a hearing needs assessment, the initial hearing needs assessment as long as such assessment was referred by the nominated treating doctor or treating specialist.
  • The Workers Compensation Commission or a registrar orders the insurer to pay for treatment expenses.

When you request pre-approval from the insurer, the insurer has a period of 21 days to respond to your request. If the insurer does not respond within 21 days, you can make a complaint to the WorkCover independent Review Office (WIRO).

If the treatment has been pre-approved and receipts have been sent to the insurer for reimbursement, the insurer must reimburse you within seven days of receiving your expenses receipts.

3. For how long does the insurer pay my medical expenses?

The period the insurer is responsible for paying reasonably necessary medical treatment differs depending on your assessment of whole person impairment (WPI):

  • 10% WPI or less: payment of medical expenses will cease 2 years from the date of the claim was made or from the date that weekly payments cease (whichever occurs later).
  • 11% to 20% WPI: payment of medical expenses will cease 5 years from the date that the claim was made or from the date that weekly payments cease (whichever occurs later).
  • 21% or more WPI: payment of medical expenses are payable for the remainder of the injured workers life.

4. What do I do if the insurer declines my treatment?

The insurer may decline to pay for your medical expenses on the basis that it is not reasonably necessary, or that it is not related to your work injury. If the insurer declines to pay for your medical expenses they will need to provide written reasons in the form of a Section 74 Notice.

If the insurer declines treatment of medical expenses over the phone, make sure you ask them to provide a Section 74 Notice in writing outlining why they have declined your request. They must by law put the reasons for declining treatment in writing within 7 days.

It is important to obtain a Section 74 Notice as it is needed to challenge the decision of the insurer.

If the medical treatment dispute cannot be resolved and you consider the treatment to be reasonably necessary, you can make an application to the Workers Compensation Commission to appoint an independent Arbitrator to hear and determine the dispute.

You will need medical evidence to support the argument that the treatment is “reasonably necessary”, you lawyer will obtain this evidence on your behalf.

If you wish to challenge the decision of an insurer, you should contact an Accredited Specialist in Personal Injury Law like Garling & Co. We can help you with your medical expenses claim, simply get in touch with us through the below;

  1. Complete our FREE case assessment form HERE
  2. Email us at info@garlingandco.com.au
  3. Give us a call on (02) 8518 1120
More Faqs

Have you suffered a serious injury?

We specialise in helping people recover compensation for serious injuries. To see if your case qualifies, please complete our Confidential Free Claim Check. Our experienced lawyers will review your information and contact you the next business day if we can help.

No Win No Fee

You won’t be required to pay any fees until we win your case.

Industry Experts

We’re industry experts with over 20 years of experience.

Maximum Compensation

Our team of expert injury lawyers will help you get maximum compensation.

Sam H.
09:47 17 Dec 24
Very knowledgeable, explains everything very clearly and highly recommend.
Rachel R.
09:13 17 Nov 24
Although a long journey, the team at Garling & Co Lawyers have been amazing. They are thorough and clear with the processes and the expectations. It is a pleasure dealing with Emma and Rebecca. They... take all the weight off our shoulders when it comes to all the legal stuff and they make us feel comfortable and confident in their ability to look after us.read more
Angie & Brian M.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more
Yanthi S.
11:22 12 Sep 24
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or told me about the kind of... negotiation in the hearing. I assumed that as a Lawyer she should have an experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Barrister only gave me less than 5 minutes to make decision and pushed me to accept the disappointed outcome and what she said in the hearing totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.As I said before I would not hesitate to let my other claim to be handled by a professional as Matthew Garling. I would like to thank him for his time and effort to settle my case smoothly and I trusted him to give me the best outcome. Also I appreciated his support and his patience to answer my questions from the time I signed the agreement up to the day before the mediation. He did not promise the unrealistic outcome but what ever he promised that what the result was according to his experiences. And I would not forget to Alison, Nathan who also have assisted this matters, by gathering all documents and answering my questions.Also my appreciation to a Barrister Mr Dallas Morgan.So, in summary I am really grateful to have Garling and Co as my lawyer to handle my damaged claim.read more
Tina S
07:45 29 Aug 24
Thank you for the great outcome!
Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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