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Medical expenses in NSW workers compensation claims

What medical and related expenses does the insurer pay?

The insurer will pay all reasonable and necessary medical and hospital treatment, ambulance services, workplace rehabilitation services, and travel expenses.

To find out how Garling & Co can assist you with your workers compensation claims, contact us today.

What Medical and Related Expenses Does the Insurer Pay?

The insurer will pay all reasonable and necessary:

Medical or related treatment

  • Treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists, remedial massage therapists, other allied health practitioners
  • Provision of artificial aids
  • Domestic assistance services (only if WPI exceeds 15%)
  • Nursing, medical and medicine supplies (provided outside of hospital treatment

Hospital Treatment

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

Ambulance Services

  • Ambulance services include emergency, non-emergency and inter hospital transfers provided by the Ambulance Service of NSW.

Workplace Rehabilitation Services

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

Travel Expenses

Any travel expenses incurred related to the workplace attending treatment for the injury, this includes:

  • Any fares such as train, bus, or ferry
  • Cost of petrol based on the kilometres driven to get to the appointments
  • If the injured worker cannot travel alone and needs assistance the insurer must pay for travel assistance.

Do Medical Expenses Require Prior Approval?

Yes,all treatment and services must be approved by the insurer prior to the cost being incurred, otherwise the insurer will not pay.

Note: This does not include any immediate and necessary treatment within 48 hours of the injury.

How do the Expenses get Paid?

You should give to your Doctors your claim number and the Doctor will bill the insurer directly. If you have paid for the treatment yourself, you will need to send to the insurer your invoices including travel expenses as you go.

Can the Insurer Decline Payment?

The insurer can decline payment of any treatment expenses if it does not accept it is reasonable and necessary or that it is not related to your work injury. If the insurer does decline payment they need to put the reasons in writing. This is called a S.74 Notice. This notice sets out why they have declined the treatment expenses and the evidence the insurer relies upon. If you receive a S.74 Notice you should speak to a lawyer immediately.

If the insurer just tells you over the phone that they are not paying for some treatment, this is in breach of the regulation. You should request that the reasons are given to you in writing in a S.74 notice. If the insurer does not do this you should contact WorkCover on 131 050.

How long does the Insurer pay for Treatment?

Payment for medical expenses are paid until;

  1. If the WPI* is 10% or less, 2 years after you last received weekly payments.
  2. If the WPI is between 11% and 20%, 5 years after you last received weekly payments.
  3. If the WPI is 21% and above medical expenses are payable for life.

If you never received weekly payments the period commences from the date of claim.

Note: There are limited exceptions. The insurer does pay for secondary surgery after 2 years if it’s related to the original surgery performed.

*WPI is whole person assessment, assessed by an independent doctor.

Should you have any questions about payment of medical expenses please contact us.

For more information on Workplace Compensation Claim Success, read our guide here.

Garling & Co Lawyers

Matthew Garling

Matthew Garling is an Accredited Specialist in Personal Injury Law approved by New South Wales Law Society. He is admitted to practice in the Supreme Court of NSW and the High Court of Australia. Matthew is also a member of...
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
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.read more
READ ALL TESTIMONIALS

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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
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.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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4.9