A certificate from a legally qualified medical practitioner must be submitted with a claim for workers’ compensation. Other forms of medical evidence may also be required.
Why medical evidence is required
When making a claim for workers' compensation, you must submit medical evidence.
Medical evidence is required:
- to make a determination on your claim
- for your claims manager to consider medical treatment and other support
- to help manage your claim and determine your capacity for rehabilitation.
Medical evidence is usually in the form of a medical certificate or medical report.
A medical certificate must be provided when you make a claim under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
Who can provide a certificate
You usually need a medical certificate from a legally qualified medical practitioner.
Under the Safety, Rehabilitation and Compensation Act 1988, a legally qualified medical practitioner can be a general practitioner or a specialist, such as a surgeon, psychiatrist or a dentist.
A medical certificate must be provided by a legally qualified medical practitioner if you want to claim for income support. The certificate needs to state how the injury or illness is related to your work.
You do not need to provide a medical certificate from a legally qualified medical practitioner if you are only claiming for treatment provided by:
- an occupational therapist
- an osteopath
- a chiropractor
- a dentist
- a psychologist
- an optometrist, or
- a physiotherapist or massage therapist.
In these cases, you can provide a medical certificate from the allied health provider stating a precise diagnosis and cause for the injury or illness.
Form of the certificate
Comcare's preferred medical certificate is the certificate of capacity as it fulfils the legal requirements of the SRC Act.
A completed state medical certificate or other medical certificate is also accepted if it meets the requirements of the SRC Act.
To help process your claim, a medical certificate must:
- contain your details
- state the precise diagnosis
- describe your symptoms
- for physical injuries, state the date it occurred
- contain a review date and not be open-ended
- list the treatment required for the compensable injury or illness.
The medical certificate must:
- be signed by the practitioner who made the examination
- be the original (not a photocopied version).
Payment of the medical certificate fee
Your claims manager can arrange payment for the initial (first visit) certificate fee in New South Wales and the Northern Territory.
Other Australian states and territories incorporate the cost of certificates into their fee structures.
Your claims manager may arrange for you to be examined by a legally qualified medical practitioner to assist with determining or managing your claim.
Your claims manager can request your treating practitioner or an independent practitioner, who has relevant qualifications in relation to your injury and has not treated you before, to conduct an examination and provide a report.
A medical report usually addresses a set of questions asked by your claims manager.
Your claims manager uses the information in the report to determine liability and assist you to return to health and work.
Medical reports explained
Medical reports describe your claimed injury or illness and are provided by a medical practitioner or a treating allied health professional.
Your claims manager may ask for a medical report to help with the management of your claim, recovery, or return to work.
Payment of the medical report fee
Your claims manager will arrange payment for the medical report they request to help manage or determine your claim.
To avoid unnecessary expense, we recommend you talk with your claims manager before you obtain a report.
In some circumstances, reports are received that were not requested. The report may have been arranged by someone other than your claims manager, such as you or your representative.
Your claims manager uses their discretion when deciding whether to pay for a report they did not request. They may consider whether:
- the cost of the report is reasonable
- the report provides relevant new information which helps manage your claim or determine benefits.
If your claims manager decides not to pay for this report, the cost of the report remains the responsibility of the person or organisation who requested it.
If this happens, your claims manager will:
- contact you or your representative
- provide reasons why the report will not be paid for.
A decision by your claims manager not to pay for a report is an administrative decision and not a determination under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act). This decision cannot be reconsidered.