Medical Expenses and Pre-Approval

Workers Compensation - Medical Expenses Pre-Approval

Gone are the days where injured workers could have reasonably necessary medical treatment and later seek to be reimbursed by the insurer. These days, without pre-approval the insurer will not pay for medical treatment, even if such treatment is proposed by the treating doctor and is reasonably necessary. There are however some exemptions to this rule including:

  • treatment in the first 48 hours after the injury
  • consultations with the nominated treating doctor (GP) excluding home visits
  • services provided in the emergency department of a public hospital
  • consultations with a specialist within three months of the date of injury
  • plain x-rays arranged by the nominated treating doctor within two weeks of the date of injury
  • ultrasounds, CT scans or MRI’s arranged by the nominated treating doctor within three months of the date of injury where the worker has been referred to a specialist for injury management
  • over the counter prescriptions by the nominated treating doctor or specialist dispensed within one month of the date of injury or after one month if prescribed through the Pharmaceutical Benefits Scheme.

In situations where pre-approval has been sought and the insurer has denied the treatment, a worker is able to have the treatment and then dispute the insurer’s decision through the Workers Compensation Commission. If it is found that the treatment was in fact reasonably necessary and therefore should have been approved by the insurer, the worker will be able to be reimbursed.

If you have any issues with the payment of your medical expenses you should contact our team of expert lawyers on workers compensation here at Taylor & Scott.

Remember, all workers compensation claims are conducted with a grant of legal assistance from WIRO meaning you pay no legal costs whatsoever. Contact us by phoning 1800 600 664 or email us at

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