Reasonably necessary medical and treatment expenses
Medical, hospital and rehabilitation expenses will be paid if the treatment or service:
- meets the definition described in Section 59 of the Workers Compensation Act 1987
- 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)
The following video explains reasonably necessary medical and treatment expenses related to workers compensation.
Medical treatment
This can include:
- treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists, and 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 for treatment or services which are reasonably necessary due to your injury. You should seek the insurer’s approval for most treatments first. The insurer does not have to pay for treatment or services that it did not approve prior to your receiving them.
Some treatments don’t require pre-approval, including:
- initial treatment (any treatment within 48 hours of the injury happening)
- consultations with your nominated treating doctor (NTD) related to your injury
- treatment during a consultation for the injury provided by your NTD within one month of the injury
- any services for the injury provided in the emergency department of a public hospital
- some treatments with allied health professionals (e.g. physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists)
Refer to Part 4: Compensation for medical, hospital, and rehabilitation expenses in the Workers compensation guidelines for details, including the timeframes for claiming medical expenses.
Hospital treatment
Prompt approval and payment for medical, hospital and rehabilitation services ensures workers can remain focused on their recovery and helps to maintain the integrity of the scheme. This includes treatment at public and private hospitals.
The insurer is responsible for the approval and payment for treatment and services during the worker’s claim.
Our Workers Compensation Claims Management Guide has more information on hospital treatment.
Ambulance services
You are entitled to payments for reasonably necessary ambulance services including 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
Approved workplace rehabilitation providers can provide:
- 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.
Workplace rehabilitation providers are health professionals who can help you recover at work.
Contact the insurer to be referred to a provider or find one using our online search tool.
Travel expenses
You can claim for travel to attend medical, hospital and rehabilitation appointments.
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 can also claim reimbursement for fares, travel costs and maintenance that are necessary and reasonable. Generally, travel costs require pre-approval by the insurer.
Our Workers Compensation Claims Management Guide has more information about medical and treatment services you may be eligible for.
When medical, hospital and rehabilitation entitlements end
Workers can claim medical, hospital, and rehabilitation expenses for:
- two years after weekly payments stop, where their degree of permanent impairment is 10% or less, or from the day the claim was first made, if no weekly payments were paid
- five years after weekly payments stop, where their degree of permanent impairment is 11 to 20% cent, or from the day the claim was first made, if no weekly payments were paid.
Workers with greater than 20% permanent impairment are entitled to medical, hospital and rehabilitation expenses for life.
Medical benefit time limits do not apply to the exempt category of workers.
For more information, speak to the insurer or the Independent Review Office (IRO) on 13 94 76.
Updated 19 December 2024