NSW workers’ compensation claims: If we could say one thing – keep good records!

Everyone has the right to go to work each day, knowing they’ll come home safely. If you’ve been injured or become ill at work you may be entitled to make a claim for workers’ compensation to cover lost wages, medical and rehabilitation costs, retraining expenses or a lump sum payment for permanent injuries. There have been a lot of changes to arrangements in NSW for seeking workers’ compensation in recent years. You could be forgiven for being a little confused about where to start. After all, workers’ compensation laws and entitlements are already a little hard to keep up with because they vary between states and territories and may be known as WorkCover, CTP or WorkSafe. Compensation and benefits can vary greatly depending on your injury and on the law you’re covered by.

Read more: Want to know what the process is for claiming workers’ compensation in NSW? Here’s how! – Littles

If you’ve been injured at work in NSW, Littles has you covered. This blog explores how you can avoid out-of-pocket expenses for medical and other expenses related to your injury.

What expenses are we talking about?

If you’re injured at work, it’s possible that in addition to requiring immediate medical attention, you may also need ongoing treatment to aid in your recovery and rehabilitation.

Your medical bills can add up quickly, particularly if your injury requires specialist treatment, or additional services like physiotherapy. 

Read more here: NSW workers’ compensation claims: I’ve been injured and my medical expenses are piling up. Help! – Littles

Under NSW’s workers’ compensation legislation, some forms of treatment can be accessed without prior approval by the insurer if your claim is accepted by your employer’s insurer. However, other services will require approval from the insurer. The insurer may ask for evidence regarding why the treatment is reasonably necessary and how it relates to your work injury.

While some people will just pay for certain types of medical treatment in the expectation they will be reimbursed by the insurer, this is not always the case.

This is why 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. The better your records, the more you are likely to get back.

So what do I need to do to avoid being out-of-pocket?

First things first. If you sustain an injury at work, it is crucial that you 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, which you can then give 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.

HANDY HINT! Treatments and services that do not require prior approval from an insurer or a medical referral to be paid for include:

· ambulance and attending the emergency department of a public hospital

· initial treatment provided within the first 48 hours of the work injury, including GP appointments

· 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 (NB: only one type of treatment will be funded at a time by the insurer)

· up to eight sessions of psychological treatment or counselling, if the treatment commences within three months of your injury.

Read more: NSW workers’ compensation claims: What’s an independent medical examination (IME)? – Littles

How do I get approval from my insurer?

Generally, your doctor or treatment provider will need to send a written request for approval to the insurer. The insurer must decide on treatment within 21 days of receiving the request.

These include things like:

· surgery

· psychological services

· pain management programs

· domestic help and vehicle modifications

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

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.

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

How much will I get back?

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. If this happens, you will need to pay the gap in costs.

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. 

Read more: Help! My NSW workers’ compensation claim has been rejected. What do I do? – Littles

IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly.

Free advice and no upfront fees 

Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.

The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice.

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles.

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