What is an approved treatment?

A worker is entitled to recover costs for their reasonable medical and related expenses. These fall under the heading of approved treatments and include such things as, visits to and treatments by the worker’s general practitioner and specialist, physiotherapist and occupational therapist.

If a worker requires treatment from an alternative health provider for example; a naturopath, they should check with their employer's insurer to ensure that their cost will be reimbursed prior to commencing treatment.

What do I charge for a workers’ compensation treatment?

WorkCover WA specifies rates billable under the workers’ compensation system. These rates represents the amount that the insurer will reimburse the worker for the treatment provided. If your rates are higher than those specified, the worker is responsible to pay the ‘gap’. You should highlight this to the worker prior to their appointment.

Invoices should be forwarded to the employer for payment, even when the claim is in dispute. If the claim is denied, your patient is responsible for prior and future treatment costs and should forward such accounts to Medicare (and/or their private health fund) for a rebate.

What codes do I use for different procedures?

• Medical practitioners can use the MBS number as their code - see the Medicare Benefits Schedule website for information.
• Practitioners other than doctors can use the service codes available on the Rates, Fees and Payments page.
• If the service provided to an injured worker is not covered or gazetted, the code may be found in either the Australian Medical Association’s List of Medical Services and Fees book, or on the Medicare Benefits Schedule website. You should discuss the payment of the service fee with the workers’ compensation insurer - the fee shown in the AMA’s book is usually acceptable to the insurer in these cases. Be sure to include a clear description of the service provided on your invoice to the workers’ compensation insurer.

Disputes over payments

Disputes over unpaid invoices should first be taken to your patient’s employer or insurer. If you are unable to resolve the dispute you can lodge an application with the Conciliation and Arbitration Services (CAS).