When can the insurer stop paying my medical treatment?

The insurer can decline or stop payment for medical treatment for the following reasons:

  1. They do not believe that the treatment is as a consequence of the injury sustained; or
  2. They do not believe the treatment is reasonable and necessary; or
  3. Your entitlement to payment of medical expenses ceases in accordance with the Workers Compensation Act.

The insurer can at any time decline to approve payment of medical treatment if they do not believe it is related to your injury or if they do not believe it is reasonable and necessary.

Medical expenses are payable as follows;

  • If no weekly payments are paid up to 12 months after the date of the injury or;
  • If weekly payments are paid up to 12 months after the last date on which you received weekly compensation benefits.

If after medical expenses cease you have a further period where you are not fit to work, and weekly payments are recommenced, the insurer will again become responsible for payment of medical expenses and approval should be sought directly from the insurer.