Injured workers in NSW can receive compensation for reasonably necessary medical and related treatment expenses, hospital treatment, ambulance service and workplace rehabilitation.
What does "reasonably necessary" mean?
Generally, treatment that at least maintains your health or slows or prevents its deterioration, will be considered reasonably necessary.
The existence of alternative treatment options that would achieve a similar result does not prevent the recommended treatment from being reasonably necessary.
What travel expenses can I claim?
You can claim the reasonable cost of transport to and from your medical appointments. If you are travelling by private vehicle, you can claim $0.55 per kilometre.
If you are required to be away from home, you can claim a reasonable amount for meals.
If you cannot reasonably travel alone, you can claim the travel expenses and meals for your escort.
You will need to provide the insurer with receipts for fares and meals.
How long can I claim treatment expenses for?
If you have 21% whole person impairment or more, there is no time limit for claiming medical expenses.
Otherwise, your entitlement to claim treatment expenses will cease 2 years after your weekly payments end (or from the date of claim if you have not received weekly payments).
That period can be extended to 5 years if you are assessed with between 11-20% whole person impairment.
What are the exceptions to the time limit?
There is no time limit to claim for provision of crutches, artificial members, eyes or teeth, and other artificial aids or spectacles (including hearing aids and hearing aid batteries).
You can also claim the cost of “secondary surgery” within 2 years of obtaining approval for earlier surgery, if is to the same part of the body and the need for surgery is a direct consequence of the prior surgery.
After the time limit has expired, if you become entitled to weekly payments again you can claim your medical expenses for the period you receive those weekly payments.
Does the insurer need to approve treatment first?
Generally, yes. Compensation is not payable for treatment obtained without the insurer's prior approval.
There are some exceptions set out in the SIRA Workers Compensation Guidelines, such as:
treatment provided within 48 hours of the injury
some initial treatment provided shortly after your injury by your nominated treating doctor (NTD), specialists and allied health professionals
services provided in the emergency depart of a public hospital
consultation and case conferencing with your nominated treating doctor
x-rays on the referral of your NTD within 2 weeks of injury
ultrasounds, CT scans and MRIs on the referral of a specialist, or your NTD if you have been referred to a specialist, within 3 months of injury
prescription drugs and over the counter pharmacy items prescribed by your NTD or specialist (after the first month, this only applies to prescriptions dispensed through the pharmaceutical benefits scheme).
treatment provided where the insurer denies liability for the treatment and the Workers Compensation Commission later determines the treatment was reasonably necessary.
What if my claim is denied or the insurer is delaying approval for treatment?
If the insurer delays approving your request for treatment you should contact the Independent Review Office (IRO) on 139476 and they will assist you to get a response from the insurer.
If your request for treatment is denied you can contact us for an obligation free legal advice.
DISCLAIMER: This blog is made available by Mortimer Fox Lawyers to give you general information and a general understanding of the law, not to provide specific legal advice. Unless otherwise stated, all information provided pertains to injuries sustained in or in connection with New South Wales. By using this blog you understand that there is no solicitor client relationship between you and Mortimer Fox Lawyers. This blog should not be used as a substitute for legal advice. If you require legal advice please contact us for an appointment.
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