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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.

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  • Check if you’re eligible for compensation

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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.

Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie

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

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 through phone and email. Please contact our experienced workers compensation 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.

Kimberly B.
23:14 14 Feb 24
Mathew is very knowledgable and has been of great assistance to me. All the staff are friendly and helpful. I'm so happy I found this firm.Thank you Mathew and team for your great work in my case.... I am 100% happy with what you achieved for me.read more
Julie M.
10:16 16 Jan 24
My last stage of Workers compensation claim was managed by Emma Perkins, Natasha Stojanovic, Rebecca Dunshea and Kelli Robinson at Garling and Co. Lawyers who went the extra mile with their service... from the beginning to the end of 3 years of my case. I have become very anxious with almost everything after a workplace injury and a lot of times I probably ask more questions than I need to, but Emma Perkins always finds clear answers to my questions in a short time and explains to me patiently even using her mealtime or between her meeting and make me feel that I have been very well take care and supported. I am so grateful and extremely satisfied. The excellent service, attitude, and culture of Metthew Garling and his team are second to none with a very high success rate. If you going to battle with your workplace injury for a short or long period, you are better off with Garling and Co. lawyers who are able back you up every step of the way. I strongly recommend it to anybody who needs their service like me. Julieread more
patrick P.
01:46 19 Dec 23
I like to say that I had a very wonderful experience,And the support, and also understanding with all my requests,I could not ask for a better team!Thank you Emma and also her assistant Rebecca... thank youread more
Kazi H.
13:38 13 Dec 23
Work cover fund is GOVT’S money but insurer think that it is from their 14th generation. So only they can have it. Not only that, people from the work, IME doctor from insurer, back to work... coordinator from work, Rehab provider from any side push the worker as hard as possible that the worker (doesn’t matter how the workers mental or psychical condition) either go back to his pre injury duty or leave the job.More over on that very bumpy any difficult journey some of them only treat the worker as a MONEY MAKING MECHINE .in some point worker feels like, no rooms to breath. On that moment need someone to support legally, someone to care, someone to relive.On my case I believe that, somehow, I manage to make my God happy. That’s why God sends me to Matthew Gerling and his team Allison, Rebecca and Nathan, and all of GARLING & co Lawyers.I am not good enough in English, can’t express my gratitude.Matthew, Allison, Rebecca and Nathan, please accept my appreciation and pass it to others.read more
Carol L.
01:32 29 Nov 23
Professional, understanding and friendly
Sean G.
23:21 14 Nov 23
Matthew Garling and everyone I spoke to at Garling and Co were kind, caring and compassionate. They were sensitive to my psychological condition and were patient in explaining everything to me, so... that I clearly understood the legal process. I am exceptionally grateful for the settlement outcome that Garling and Co obtained for me. Many thanks.read more
waqas A.
08:33 13 Nov 23
Great Experience with Garling & Co. Matthew explained everything in detail during the first appointment. Allison, Nathan, Rebecca and the staff have been extremely helpful. Thank You to the team and... lawyers at Garling & Co. for making the long process easy for me and getting an excellent outcome for my compensation claim.I would highly recommend Garling & Co. Lawyersread more
Saskia L.
21:42 08 Nov 23
The world of workers compensation is long, hard and confusing, but Emma and Rebecca at Garling & Co always treated my case with kindness, respect and understanding. No question was ever silly and... they always had time to make sure I knew what would happen next and how we could best prepare. I am so thankful for their expertise and could not have chosen anyone better to represent me.read more
Antonio P.
08:46 06 Nov 23
Thank you Matthew and his team for taking care of my case couldn’t ask for a better results and couldn’t have better team to do that thank you
Julie M.
00:40 06 Nov 23
Garlic & Co Lawyers have been wonderful, supporting me through some difficult times. With their assistance, positive outcomes were achieved. Many thanks to the Team.Julie
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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