If you are injured at work, you may claim for a range of reasonable medical expenses, including:

• first aid and ambulance
• medicines
• medical or surgical attendance
• treatment by specialists
• dental
• physiotherapy
• chiropractic
• charges for hospital treatment
• other approved treatment, including osteopathy, clinical psychology, occupational therapy, speech pathology, and exercise physiology.

You also have the right to be treated by a doctor or allied health provider of your choice. You will need to forward bills to your employer or the insurer for payment.

You may have to pay a ‘gap’

The insurer will only pay medical accounts up to the medical and allied health provider rates set by WorkCover WA. If your provider charges more than this rate, you will be responsible for the extra portion of the account (the ‘gap’). Check the charges with the provider before making an appointment.

Total payments for medical expenses are limited

The amount you can receive to cover your medical expenses over the life of your claim is limited. The insurer will notify you once 60% of the maximum amount for medical expenses has been reached. For more information, see the Prescribed Amount.

In certain circumstances, you may lodge an application with the Conciliation and Arbitration Services (CAS) for an extension of the medical expenses amount. The CAS will take into account your social and financial circumstances and your reasonable financial needs when considering your eligibility for an extension. If you exhaust the medical entitlement, an additional $2000 for medical and related expenses will be available while you pursue an extension.

Exceptional circumstances medical payments

If a worker meets exceptional medical circumstances criteria and has a whole of person impairment of not less than 15%, a CAS conciliation officer or arbitrator may grant an extension of up to $250,000 beyond the additional $50,000 for medical expenses. Note that if you accept exceptional circumstances payments, you automatically waive your right to pursue common law damages.

For more information, download the Exceptional Circumstances Medical Payments Brochure (PDF - 2.24MB).