You may be eligible to claim the costs of some or all medical treatments and services.
Treatments and services can include:
This can include:
- treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists, other allied health practitioners
- provision of artificial aids
- domestic assistance services
- nursing, medical and medicine supplies (provided outside of hospital treatment)
- modifications to your home or vehicle
Your insurer will only pay expenses for approved treatment or services which are reasonably necessary, so you should seek the insurer’s approval for most treatments first.
But some treatments don’t require prior approval in order for you to claim expenses.
These can include:
- treatment provided within the first 48 hours following the injury
- consultation with the nominated treating doctor apart from telehealth and home visits
- if referred by the nominated treating doctor, any consultation and treatment during consultations for the injury (apart from telehealth), within three months of the date of injury prescription and over-the-counter pharmacy items prescribed by the nominated treating doctor or medical specialist for the injury and dispensed within one month of the date of injury, or after one month of the date of injury if prescribed through the Pharmaceutical Benefits Scheme.
- all plain x-rays performed on referral from the nominated treating doctor or specialist medical practitioner in relation to the injury claimed and provided within two weeks of injury
- services provided in public hospitals, that are provided by or consequent upon presentation at the hospital's emergency department, for the injury claimed that are within one month of the date of injury
- some consultations for physiotherapy, osteopathy or chiropractic treatment
- some psychology treatment or counselling
It is very important to read the full details including the time frames for claiming expenses in Part B of our 2016 Guidelines for claiming workers compensation.
You may only claim for the cost of medical and related treatment, hospital treatment and rehabilitation services during a specific compensation entitlement period. The compensation period that applies to you depends on whether or not your injury has resulted in an assessed degree of permanent impairment
Workers with no permanent impairment or a permanent impairment assessed as 1 to 10 per cent can claim expenses for treatment or services provided:
- from the date of claim to two years after weekly payments stop being payable, or
- for two years from the date of claim if no weekly payments made.
Workers with a degree of permanent impairment assessed as 11 to 20 per cent can claim expenses for treatment or services provided:
- from the date of claim to five years after weekly payments stop being payable, or
- for 5 years from the date of claim if no weekly payments made.
Workers with high needs can claim expenses for life. This refers to workers:
- with a permanent impairment assessed as greater than 20 per cent or
- where an approved medical specialist has declined to make an assessment the worker has not reached maximum medical improvement or
- for whom the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent.
This includes treatment at public and private hospitals.
This includes emergency, non-emergency and inter hospital transfers provided by the Ambulance Service of NSW.
These services are provided by approved workplace rehabilitation providers and include:
- 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
You can claim for travel to attend medical, hospital and rehabilitation appointments.
The maximum amount payable if you’re using a private motor vehicle transport is $0.55 per kilometre. This amount is reviewed every 12 months.
You will need to keep:
- a record of the kilometers if you use a private motor vehicle
- receipts for public transport