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.

See the Rates, fees and payments page to view how WorkCover WA quantifies these entitlements.

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

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.

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 Workers’ Compensation Conciliation Service.

Medical practitioners

Medical practitioners can use the MBS number as their code – see the Medicare Benefits Schedule website for information.

Other practitioners

Practitioners other than doctors can use the service codes available on the Rates, fees and payments page.

Service code not available?

If the service provided to an injured worker is not covered, the code may be found in either the Australian Medical Association’s List of Medical Services and Fees, 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 List 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.

Billing practices for medical and radiology services

WorkCover WA has released a Notice regarding billing practices for medical and radiology services. The Notice reinforces MBS rules and principles in charging for services provided to injured workers.