Medical, hospital and rehabilitation expenses
You may be eligible to claim the costs of some or all medical treatments and services.
Medical and related treatment
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.
The insurer will only pay expenses for treatment or services which are reasonably necessary as a result of your injury, so you should seek the insurer’s approval for most treatments first.
Generally, the insurer does not have to pay for treatment or services they have not approved before you undergo the treatment. However, some treatments don’t require pre-approval in order for you to claim expenses. These include but are not limited to:
- initial treatment (any treatment within 48 hours of the injury happening)
- consultations with your nominated treating doctor (NTD) in relation to your injury
- treatment during a consultation for the injury provided by your nominated treating doctor within one month of the injury
- any services for the injury that are provided in the emergency department of a public hospital
- some treatments with allied health professionals (eg. physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists).
Refer to Part 4 of the workers compensation guidelines for full details including the time frames for claiming medical expenses.
Hospital treatment
This includes treatment at public and private hospitals.
Ambulance services
This includes emergency, non-emergency and inter hospital transfers provided by the Ambulance Service of NSW and other providers as specified in the workers compensation (ambulance service fees) order.
Workplace rehabilitation services
These services are provided by approved workplace rehabilitation providers and can include:
- support for worker to recover at or return to work
- vocational, functional and workplace assessments
- job analysis and modification
- identification of suitable work
- worker retraining and placement in employment.
Travel expenses
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 $0.58 per kilometre.
You will need to keep:
- a record of the kilometres if you use a private motor vehicle
- receipts for public transport.
If you require an escort to travel with you for an approved treatment or service, they are also able to be reimbursed for fares, travel costs and maintenance that have been necessarily and reasonably incurred.
Generally, travel costs require pre-approval by the insurer – unless the travel is for treatment exempt from pre-approval.
Learn more about medical and treatment services you may be eligible for.
Understanding reasonably necessary medical and treatment expenses in relation to workers compensation
The below video takes you through understanding reasonably necessary medical and treatment expenses in relation to workers compensation.
Eligibility and how to claim treatment and services
Medical, hospital and rehabilitation expenses will be paid where the treatment or service:
- meets the definition described in section 59 of the 1987 Act
- takes place while the worker is entitled to receive compensation for the medical, hospital and rehabilitation expenses
- is pre-approved by the insurer (unless the treatment or service is exempt from pre-approval)
You or the service provider should give the insurer enough information to determine whether the treatment or service you have asked for is or was reasonably necessary.
The information may include:
- your workers compensation certificate of capacity recommending treatment
- allied health recovery requests
- specialist referrals or reports.
If the insurer requires more information, they should contact the treatment or service provider first.
How long am I covered for?
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 10 per cent or less can claim expenses for treatment or services provided:
- for 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 more than 10 per cent but not more than 20 per cent can claim expenses for treatment or services provided:
- for five years after weekly payments stop being payable, or
- for five years from the date of claim if no weekly payments made.
Workers with high needs can claim medical and related expenses for life. A worker with high needs is a worker:
- with a permanent impairment assessed as more than 20 per cent
- an assessment of the degree of permanent impairment is pending and has not been made because an approved medical specialist has declined to make the assessment on the basis that maximum medical improvement has not been reached and the degree of permanent impairment is not fully ascertainable, or
- the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent.
Further information
If you need help or advice, speak to the insurer or contact the Independent Review Office (IRO) on 13 94 76.
To help understand your entitlements, head to the Have you been injured at work? guide or the SIRA claims management guide. These resources provide a breakdown of your entitlements.
Documents
- The workers compensation benefits guide contains the past and current benefits payable for medical, hospital and rehabilitation expenses.
Dust diseases
If you've contracted a compensable dust disease because of your work, you need to contact icare dust diseases care, also known as the Dust Diseases Authority (DDA).
They provide compensation, treatment and support for workers and their families.
Along with compensation, they also fund ongoing assistance to support quality of life. This can include mobility aids, personal care, medication and treatment from health professionals, as well as general assistance such as domestic support and respite care for families.
Disputes
Sometimes there can be disputes about compensation. If there’s a dispute, there’s help available. Our workers compensation disputes section has more information.