Medical and related services

Treating specialists are medical practitioners who have undertaken further training to develop expertise in a specific area of medicine.

A nominated treating doctor may refer a worker to a specialist when their expertise is necessary for diagnosis or treatment.

The nominated treating doctor continues to be the worker’s main contact, and the specialist will communicate regularly about the worker’s care and any treatments, medications or procedures they require.

There are over 60 different types of treating specialist in Australia. Those most commonly referred to in workers compensation cases include:

• occupational physician
• general surgeon
• orthopaedic surgeon
• neurosurgeon
• pain management specialist
• psychiatrist
• neurologist
• rehabilitation physician
• sports physician.

A worker who has been referred to a specialist may find the Preparing for my specialist appointment brochure useful.

Communication with the treating specialist

The nominated treating doctor is the main point of contact for the insurer to obtain information and guidance about the worker’s injury and recovery. If a worker chooses their treating specialist to act as their nominated treating doctor, the specialist is then required to sign and agree to comply with all the obligations of the nominated treating doctor (see 'Nominated treating doctor').

It may be necessary for an insurer to contact a treating specialist to discuss proposed treatment or the worker’s progress.

When a treating specialist is involved in a worker’s treatment, the insurer should seek clarification from the treating specialist regarding treatment and return to work before referral to an independent medical examiner is considered.

Fees and invoices

Fees for treating specialists are set out in the Medical Practitioner Fees Order posted on the SIRA website. There are separate Fees Orders for surgeons and orthopaedic surgeons (see also ‘Surgery’).

The Fees Orders specify how much can be charged and what codes specialists are to use. Fees Orders specify the maximum amount payable per service and any service restrictions, and reiterate that workers are not liable for these costs.

No fees are payable for cancellation or non-attendances. Pre-payment of fees for reports or services is not permitted.

Invoices should include:

• the worker's first and last name, and claim number
• payee name, address, telephone number and email address
• payee Australian Business Number (ABN)
• name of the relevant service provider who delivered the relevant service
• in the case of medical practitioner services, the provider’s:
  • Medicare provider number (unless not registered with Medicare).
  • Australian Health Practitioner Regulation Agency (AHPRA) number
• in the case of invoices for surgery:
  • a detailed operation report including a description of the initial injury and an outline of the mechanism of injury, time surgery commenced and finished, intra-operative findings and the procedures performed, including structures that were repaired (stating the anatomic location) and technique of repair.
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fee List item number (where applicable). Refer to the relevant Fees Order and the Workers compensation insurer data reporting requirements.
• service cost for each SIRA payment classification code or AMA Fee List item number and service duration (if applicable).
• the date of service
• the date of invoice (must be on the day of or after last date of service listed on the invoice)

To prevent delays in payment, these details need to be provided on all invoices.