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When the medical entitlement period ends

Information for workers and health providers about the medical entitlement limit (section 59).

Under section 59A of the Workers Compensation Act 1987, workers can claim medical, hospital, and rehabilitation expenses for:

  • two years after weekly payments stop, where their degree of permanent impairment is 10 per cent or less
  • five years after weekly payments stop, where their degree of permanent impairment is 11 to 20 per cent.

Workers with greater than 20 per cent permanent impairment are entitled to medical treatment, service or assistance for life.

Medical benefit time limits do not apply to the exempt category of workers (such as police officers, paramedics or fire fighters, coal miners or volunteers).

Information for workers

If you are reaching your medical entitlement limit, we encourage you to plan for a smooth transition onto alternatives outside the workers compensation system. Contact your insurer case manager, GP and treating health provider for help to plan your transition to alternative treatment and support.

More details information about your entitlements and alternative supports are detailed in this factsheet.

Information for health providers

If your patient is approaching the reaching the end of their eligibility period for medical, hospital and rehabilitation expenses, we encourage you to help them plan for a smooth transition onto alternative options outside the workers compensation system.

It is important to:

  • discuss and inform the worker of the medical and support services available to them and make referrals where appropriate to publicly-funded community, state or federal systems, or where applicable, services funded by private health insurers.
  • prepare a discharge plan to promote independence from health care and assist with longer-term management of the injury or condition
  • inform them that the costs of any treatment or services provided after that date will be their responsibility.

Treatments or services provided after the end date will not be paid by the insurer, even if it was approved prior to the end date.

More information about the worker’s entitlements and alternative supports are detailed in this factsheet.

More information on the end of medical entitlements.

If you have any questions speak to the insurer or contact the Workers Compensation Independent Review Office (WIRO) on 13 94 76.