Why You Need to Keep Records to Recover Out-of-Pocket Expenses in Workers Compensation Matters (NSW)

workers compensation

If you’re injured at work, it’s likely you’ll not only need immediate medical attention but also ongoing treatment to aid in your recovery and rehabilitation.

Medical consultations can be expensive, particularly if your injury requires specialist treatment. It’s easy to quickly find yourself significantly out-of-pocket, despite the fact your injury may be covered under a Workers Compensation claim.

Under NSW’s Workers Compensation scheme, if your claim is accepted by your employer’s Workers Compensation insurer, some forms of treatment can be accessed without prior approval by the insurer.

Other treatments, however, require approval from the insurer based on evidence regarding why the treatment is reasonably necessary and how it relates to your work injury.

Some people will go ahead and pay for certain types of medical treatment in the expectation they will be reimbursed by the insurer but this is not necessarily the case.

For this reason, it’s important to keep thorough records of out-of-pocket expenses for medical treatment, related travel and any other costs connected to your Workers Compensation claim.

How expenses are dealt with in NSW Workers Compensation claims

The most important thing to do after you sustain an injury at work is to notify your employer and lodge a Workers Compensation claim with your employer’s Workers Compensation insurer. Once the claim is accepted by the insurer, you’ll be issued a claim number. This can be given to providers of medical treatment to access certain services without the need for prior approval from the insurer or a referral from a medical practitioner.

Treatments and services that do not require prior approval from an insurer or a medical referral to be paid for under the Workers Compensation scheme include:

  • ambulance;
  • initial treatment provided within the first 48 hours of the work injury;
  • services provided in an emergency department of a public hospital relating to your injury;
  • consultations with a nominated treating doctor (usually your GP);
  • some diagnostic investigations within a certain period from the date of injury (for example, x-rays within two weeks and other investigations such as ultrasounds and MRIs within three months);
  • some pharmaceutical items prescribed by your nominated treating doctor or medical specialist;
  • up to eight consultations for physiotherapy, osteopathy or chiropractic treatment (only one type of treatment will be funded at a time by the insurer), or up to eight sessions of psychological treatment or counselling, if the treatment commences within three months of your injury.

Don’t forget to keep accurate records

Other treatments and services require pre-approval from the insurer. Generally, this requires your doctor or treatment provider to send a written request for approval to the insurer. The insurer must decide on treatment within 21 days of receiving the request.

Surgery, psychological services, pain management programs, domestic help and vehicle modifications are examples of services that may be covered by the insurer.

The costs of workplace rehabilitation services such as retraining, vocational assessment and case management may also be covered by the insurer.

In most cases, your healthcare provider will invoice the insurer for your treatment, but in other situations, you may choose to pay upfront and then seek reimbursement for the expense.

In this situation, the cost of the treatment should be submitted to the insurer within six months of the appointment. The insurer then has 30 days to reimburse you.

Some treatment providers will charge for medical treatment at a rate above those listed in the Medicare Benefits Schedule, which insurers use to assess reimbursement. When this happens, you will need to pay the gap in costs.

You may need to travel for medical treatment related to your work injury, particularly if you live in a rural or regional area. Travel costs can be claimed from the insurer provided you submit them on an approved claim form.

It’s important to keep accurate records of travel expenses, including mileage if a private car was used and receipts for public transport. Mileage is paid at a maximum of $0.55 per kilometre for attendance at medical, hospital and rehabilitation appointments, but this rate is reviewed yearly by the State Insurance Regulatory Authority (SIRA).

How expert legal advice can help

At Bourke Legal, we are experts in compensation matters, including Workers Compensation claims.

If you have been injured at work, call us today for an initial consultation about your case. We will help you bring the evidence supporting your claim together, including records of your reasonable expenses for medical treatment, services and travel to appointments and advise you about what treatment and services the insurer must pay for.