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Cessation of medical, hospital and rehabilitation expenses (Section 59A): Information for health providers

A pdf of this factsheet is also available.

Overview

Under workers compensation legislation, workers may claim medical and related treatment, hospital and rehabilitation expenses during specific compensation entitlement periods.

The compensation entitlement period that applies to a worker depends on whether their injury has resulted in an assessed degree of permanent impairment, and the impairment percentage.

What does this mean?

Unless a worker’s injury has been assessed with a permanent impairment of greater than 20 per cent, their entitlement to weekly payments of compensation will cease after they have received a total of 260 weeks (five years) of payments.

Workers whose entitlement to weekly payments of compensation has ceased will however, continue to receive reasonably necessary medical treatment and services as follows:

  • 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.

Everyone’s circumstances are different. Workers should speak to their insurer and/or treating health provider/s regarding their situation.

What happens next?

The insurer will contact the worker to ensure the necessary steps are fully understood and the required level of support continues to be provided.

Insurers will provide written notification to a worker and the nominated treating doctor before the cessation of medical benefits.

Exempt categories of workers

The information provided in this fact sheet does not apply to:

  • exempt categories of workers (police officers, paramedics or fire fighters)
  • coal miners
  • volunteers prescribed by the Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987, or other voluntary work or unpaid employment.

Legislation

Information provided in this factsheet is based on the Workers Compensation Act 1987.

Medical benefit entitlements are covered under Sections 59, 59A and 60 of the Workers Compensation Act 1987.

Questions

Should you have any queries, please contact the insurer. If you are unable to resolve your enquiry with them, you can seek assistance from the State Insurance Regulatory Authority on 13 10 50 or contact@sira.nsw.gov.au

More information

Further details including a range of help and support services, is available from the SIRA website here.