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
- pain management specialist
- 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
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
- the date of invoice (must be on the day of or after last date of service listed on the invoice)
- the date of service
- name and ABN of the medical practitioner or service provider who provided the service
- payee details
- SIRA workers compensation approval number or medical practitioner's Health Insurance Commission provider number (where applicable)
- SIRA workers compensation payment classification code or AMA item number where applicable. Refer to the relevant Fees Order on the SIRA website and the Workers compensation insurer data reporting requirements.
- service cost for each SIRA workers compensation payment classification code or AMA item number and service duration (if applicable).
To prevent delays in payment, these details need to be provided on all invoices.
- Workers compensation insurer data reporting requirements
- Clinical Framework for the Delivery of Health Services
- Workers compensation guide for medical practitioners
- Preparing for my specialist appointment
- Certificate of capacity / certificate of fitness form
- Fees and rates orders
- AMA presentation on the role doctors play in the NSW workers compensation system