Medical treatment on WorkCover

Below are the 11 most frequently asked questions asked and answers  about medical treatment whilst on workcover.

medical-treatment-workcoverMedical treatment on WorkCover: FAQ

An injured worker does not need to accept treatment from a company doctor

Companies often try to convince injured/ill workers to be assessed and treated by a doctor chosen by their company/employer. The company/employer can’t force an injured worker to see the company/employer doctor for treatment. However they can require you to attend a doctor of their choice for an assessment (not ongoing treatment) but they must give you notice in writing of this assessment.

An injured worker is allowed to be treated and should always be treated by their doctor of choice

An injured worker has every right to see their own GP or other any doctor for medical treatment. You will also feel more comfortable dealing with your own GP, or a doctor you are familiar with. It really helps a lot with your workcover claim if you have a good relationship with your treating doctor.

An injured worker can change doctors if they are unhappy with the treatment they are receiving

If you have consulted with the company doctor, or even your own doctor, and you are unhappy with the treatment you have received, please change your treating doctor. You don’t have to continue to see the same doctor during the course of your workcover claim, and you have the right to seek a second opinion. In VIC for example, WorkCover (insurer) will pay for a second opinion with any specialist (i.e surgeon).

In SA if you disagree with a medical report or recommendations of a company doctor or other medical examiner, you do not need to accept this opinion. You should seek advice from a lawyer and get a second opinion from another medical expert.

Generally speaking you can always dispute a medical report or opinion from any independent medical examiner (IME). For example, if your case manager has decided to cease your weekly payments, or has refused to pay for your surgery based upon an IME report (which you believe to be biased), you can dispute the insurer’s decision. In VIC for example you lodge a conciliation (within 60 days of the notice).

Reimbursement for medical and other expenses

You should never be personally out of pocket for medical and like expenses (including medication) relating to your workcover injury, as long as the expenses are reasonable. Sometimes you do need to pay for expenses and then seek reimbursement from your workcover insurer case manager. But reimbursement should be provided quickly, and if several weeks go by without receiving reimbursement, you should make a formal complaint to the insurer and seek legal advice.

Many pharmacies also direct bill your insurer, which is very handy and a must if you require ongoing and/or expensive medication.

Note: Some states have “caps” on things like parking fees for attending an IME or Medical Panel, or on accommodation, meal allowances and wages for your time lost at work to undergo an examination.

Never ever perform duties that your doctor has restricted you from performing

Even if your employer or workcover case manager is pressuring you to perform duties (work) beyond your capacity, you should not do anything beyond what the doctor has cleared you to perform on your certificate of capacity. For example, if the doctor has said that you should not lift more than 5kg, but your employer wants you to perform heavy lifting, you should refuse the employer’s request, it is your right.

Always have an up-to-date WorkCover Medical Certificate

It can also helpful to carry around a copy of your up-to-date WorkCover Medical Certificate in case you are asked to perform tasks beyond your capacity. It helps to be able to easily show the Certificate in the workplace to ensure you are only performing duties that a doctor has cleared you to perform.

Most states require you to submit a new updated certificate of capacity every 28 days. Note that if you suffer from relatively serious and permanent or long-term injuries you may ask your case manager to allow you to provide 3 monthly certificates of capacity.

Unfortunately, many employers and insurance case managers are only looking out for the best interests of the company and/or  WorkCover . The less compensation, benefits or rights they provide to the injured worker, the more money they save. If you think that decisions are being made that are not in your best interest, seek legal advice immediately, particularly if your concerns relate to medical treatment.

Never sign a document without first seeking legal advice

Employers often ask injured workers to sign documents giving the company/employer the right to obtain all of your medical records, speak directly with your doctor and even be present when you consult with doctors. Do not ever sign any document without seeking advice. Even if you have signed a document consenting to your employer accessing all your records, etc, you can always subsequently withdraw your consent.

Your employer, rehabber, case manager etc. is not allowed to attend any of your medical appointments without your explicit consent

Don’t allow them to attend your medical appointments! They will do so in order to pressure you doctor into releasing you to (more) work, to have your doctor change your restrictions etc.

Most decisions of your workcover case manager or employer can be disputed

Do not simply accept a decision of your case manager or your boss/company in relation to your workcover claim if you disagree with the decision. Most decisions can be appealed, i.e. in VIC through conciliation, in SA to the Workers Compensation Tribunal etc.

You are allowed to attend an emergency department of a private hospital

5 Responses to “Medical treatment on WorkCover”

  1. Hello, I live in Victoria. I won my claim for mental injury but now prefer to attend a private Psychiatrist for which I pay. I also pay for private health insurance to cover my respite admissions to a private psych hospital as needed. Does my case manager have any right to access the files of this Psychiatrist or in the absence of that, insist on my GP (the insurer pays for my visits to him) providing a copy of my latest discharge summary sent to him?

    • @Marielle, if you signed the WorkCover Claim Form Authority to obtain medical information, then “yes they can” because you have given them authority to obtain any information related to your claim. Revoke that authority and re-issue another that is in line with legislation but will prevent them from accessing your records without your express written consent. This can be done by a Solicitor or u can do one yourself. Yell out if you need help.

      • Hello Donny, thank you so much for your reply. The case mgr was quite anxious (!) that I am seeing a Psych privately as she ‘needs information so she can properly manage my claim’ . She said she would ‘write a letter to my GP asking him for information about my recent admission’. !! She was not, at this stage anyway, going to write to the private Psych. Is it enough for me to write to the Case Manager saying that I revoke any previous authority to access my information but that I am happy to sign one that is ‘in line with legislation but requires my consent to access privately paid for records’? It is quite extraordinary that case managers without any clnical knowledge can have such powers over our claims! I live in a rural area with few resources and I have asked on numerous occasions for info on resources from the (city based) case manager whose response is invariably ‘ask your GP’ !! Thank you again Marielle 🙂

        • What State are u in?

          • @Marielle, sorry I see u said Vic. I can’t give legal advice but I do know you are able to revoke the original medical authority which you signed on the Claim Form. It’s the first thing a Solicitor will usually do when you engage one. If u do it urself WorkCover will try to bluff you and say that if they don’t give them any medical authority then they can’t get information necessary to manage your claim. That’s kind of true but you can issue another medical authority in a different form as long as it complies with the legislation. i.e. ACA 1985 s103(3) or WIRC 20(3) …..“A claim for compensation (other than a claim arising from the death of a worker) must include an authority, signed by the worker, authorising a provider of a medical service or hospital service to the worker in connection with the injury to which the claim relates to give to the Authority, self-insurer or employer information regarding the service relevant to the claim.”

            Read that VERY carefully and you will see that you can comply with legislation without their authority that you signed.

            Let us know if u need more help.

read-before-u-commentThis is a statement pointing you to our seriously injured but esteemed and honourable Social Networking Sites Warning and our comment policy. A must read in the context of a very adversarial workcover system! Remember to mention in which state you reside if you seek advice.

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