Medical Expenses & Treatment

Questions and Answers

Who do I speak to first when I have been injured at work?

If you have been injured at work it is advisable to speak to a qualified workers compensation lawyer as soon as possible to make sure that you are receiving appropriate workers compensation benefits and to maximise potential claim outcomes. You should also inform your employer so they can contact their insurer. If your worker’s compensation claim is disputed, Taylor & Scott can communicate with the insurer and negotiate on your behalf, with the weight of the law on your side.

What could count as a workplace injury?

Workplace injuries can occur in any workplace situation although they are more common in dangerous and physically demanding jobs, although they can occur due to wide-ranging harmful, unplanned or critical situations that arise. Risks and hazards in the workplace include falling from heights, heavy lifting, repetitive strain, unsafe and slippery floors, poorly maintained equipment, falling debris and many more. Employers and business owners are obliged to create a safe and healthy environment for employees and visitors, with any negligence or breach of duty of care potentially causing injuries that can result in workers compensation and work injury damages claims.

What is included in medical expenses?

If you are injured in a work injury a range of medical expenses may be paid by the worker’s compensation insurer.

Medically related treatments

Any treatment by a doctor, physiotherapist, osteopath, chiropractor, psychologist, an exercise psychologist, remedial massage therapist, counsellor or other allied health practitioners can be covered. You are also eligible to claim for nursing care and medical supplies outside of the hospital, along with the provision of artificial aids. Domestic assistance is available provided you have sustained more than 15% diminished physical capacity as a result of the injury.

Hospital treatments

This includes treatment received at both public and private hospitals and accredited rehabilitation centres.

Ambulance services

These services include emergency services, non-emergency services and hospital transfers overseen by the Ambulance Service of NSW.

Workplace rehabilitation services

A range of assistance is available, including return to work programs, vocational assistance, job or workplace modification and other return-to-work programs.

Travel expenses

This includes travel by taxi, bus, train or ferry for attending treatment centres for your injury. You can also claim the cost of petrol for travel to appointments, and if you are unable to travel alone, the insurer is obliged to pay for travel assistance.

Are there time limits on my medical expenses claim?

If you have been injured at work, the worker’s compensation insurer will be liable to pay all medical and hospital expenses provided they have been preapproved by the insurer (this does not apply to expenses incurred in the first 48 hours after an injury) while ever weekly compensation payments are paid. If no weekly compensation payments are paid the insurer will be liable to pay medical, hospital and related expenses for up to 2 years from the date of injury. If weekly payments of compensation are paid, the insurer will be liable to pay medical, hospital and related expenses for up to 2 years from the date of the first cessation of payments. If you have sustained at least 11% whole person impairment the 2-year time limit becomes a five-year time limit. If you have sustained at least 21% whole person impairment, there is no time limit to claim for medical expenses. Your Taylor & Scott Lawyer will guide you through the claims process.

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How long does the insurer have to make a decision on medical treatment?

The insurer has 21 days to determine a claim for medical expenses.

What is domestic assistance?

Domestic assistance can include a lot of tasks around the home that you are no longer able to carry out due to pain or injuries. This includes household cleaning, laundry, lawn and garden care, plus transport needs not covered by medical, hospital and rehabilitation expenses.

Can I claim for domestic assistance?

In order to claim for domestic assistance an injured worker must:

  • Be certified by a medical practitioner that domestic assistance is reasonably necessary based on a functional assessment and that the need for domestic assistance arises from the injury;
  • Establish that the worker performed the domestic task prior to the injury;
  • Have 15% whole person impairment or more.

In some situations, temporary assistance may be available for up to three months.

What is secondary surgery?

Secondary surgery is surgery that is a direct consequence of an earlier surgery and affects a part of the body affected by the earlier surgery and that is approved within two years from the date the original surgery was approved.

The actual surgery, however, does not need to occur within this two-year time frame; it just needs to be approved.

What information do I need to make a medical expenses claim?

In order to make a legal claim for medical expenses, you will need to provide receipts related to your claim. These can include receipts related to medical and hospital treatments, ambulance services, rehabilitation services and travel expenses. Your claim number should be attached to all documents. If an employer or insurer disputes your medical expenses claim, Taylor & Scott will examine the documents and support your claim wherever possible for best possible outcomes. For legal advice related to your medical expenses claim, medical negligence, lump sum payments and other important matters, contact us today.

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