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Medical treatment

For: Claimants Advocates

You can be reimbursed for reasonable medical, hospital, pharmaceutical and other treatment costs incurred from the date of your injury or illness, when liability has been accepted under a claim for compensation.


Types of medical treatment

  • Medical treatment provided by a legally qualified medical practitioner, including your general practitioner (GP), surgery and hospital.
  • Prescribed medicines
  • Medical aids, such as glasses, orthopaedic shoes and artificial limbs.
  • Treatment, examinations and tests, such as pathology and x-rays, supervised or directed by a legally qualified medical practitioner.
  • Treatment by registered dentists.
  • Treatment by registered allied health professionals, such as physiotherapists, osteopaths and chiropractors.

How to request approval for treatment

To request medical treatment, discuss your treatment needs and submit a claim form to your claims manager.

Employees of an Australian Government agency or statutory authority

It is important to seek approval for medical treatment in advance, wherever possible.

The steps for requesting medical treatment approval are:

  1. Discuss treatment requirements with your medical provider.
  2. Get a written plan for your treatment from your medical provider. This may be included in your medical certificate.
  3. Send the plan for your treatment to your claims manager.
  4. Your claims manager will write to advise you of the decision on approval of the costs, unless they need more information. If your claims manager needs more information, they will write to you or your general practitioner (GP).
  5. Once you complete the treatment, submit the form with an invoice or receipt by email to general.enquiries@comcare.gov.au or by mail to Comcare, GPO Box 9905, Canberra ACT 2601.
  1. Payment is usually made within 28 days of receiving the invoice.

Employees of a self-insured licensee

If you work for an organisation which is a self-insured licensee, a staff member in your organisation or a third-party provider manages your claim. Speak with your human resources team for more information.

See a list of corporations and organisations with a self-insurance licence.

Payment limits

Claims managers can decide how appropriate treatment fees are on a case-by-case basis or by referencing the payment limits that Comcare recommends.

Payment limits are based on the fees recommended by various professional associations and other Australian workers’ compensation authorities.

See Rates for medical and allied health treatment, for information on the payment rates which guide the amount that will be reimbursed for medical services.


Policies for Comcare-managed claims

These policies apply to medical treatment if your claim is managed by Comcare.

Cancellation or non-attendance

Comcare will not pay for non-attendance or cancellation fees, where you have made an appointment for medical treatment and failed to attend.

Physiotherapy treatment

Physiotherapy treatment overview

Comcare can fund the reasonable cost of physiotherapy treatment you need as a result of a work-related injury.

Your physiotherapist must be registered with the Physiotherapy Board of Australia.

We can fund the reasonable cost of physiotherapy services where:

  • there is clinical justification for treatment
  • the treatment is likely to be effective and achieve or maintain measurable functional improvement
  • the treatment helps you move towards functional independence, participation and self-management.

Starting treatment

You do not need a referral from a medical practitioner to start physiotherapy.

Comcare can fund an initial five sessions of physiotherapy. After this, your physiotherapist needs to submit a Physiotherapy Treatment notification plan (PDF, 111.5 KB) for you.

A Treatment Notification Plan must be completed and submitted when:

  • your physiotherapy is expected to exceed five treatment sessions
  • there has been a gap in treatment more than 12 months
  • you attend a new physiotherapy clinic.

Only one Treatment Notification Plan is usually required during the life of the claim. All fields on the Treatment Notification Plan must be completed.

If reasonable additional physiotherapy services are needed at the end of a treatment plan, your physiotherapist must call your claims manager to discuss your progress and the need for further services.

Physiotherapists should not submit multiple Treatment Notification Plans, a report or review plans unless specifically requested by Comcare.

Significant gaps in treatment

A gap in treatment is when you have not received physiotherapy services for more than 12 months.

Following a gap in treatment, Comcare can fund physiotherapy services after:

Ongoing treatment

If you are receiving long-term physiotherapy services, we may ask for a review of your treatment goals and progress.

We will write to the physiotherapy service provider and ask for a Review Treatment Plan. This is done on a case-by-case basis.

We send the Review Treatment Plan form to your provider to complete.

Psychology and counselling treatment

Psychology and counselling treatment overview

Comcare can fund the reasonable cost of psychology or counselling treatment you need as a result of a work-related injury or illness. This service must be referred by, and be under the supervision of, a legally qualified medical practitioner.

Comcare can fund the reasonable cost of psychology or counselling services where:

  • there is clinical justification for treatment
  • the treatment is likely to be effective and achieve or maintain measurable functional improvement
  • the treatment promotes progress towards functional independence, participation and self-management
  • Comcare has received an up-to-date referral (within 12 months) from a legally qualified medical practitioner.

Starting treatment

Comcare can fund an initial five sessions of psychology or counselling. The sessions must not exceed 60 minutes. After this, your psychologist or counsellor needs to complete and submit a Psychology and Counselling Treatment notification plan (PDF, 128.2 KB).

A Treatment Notification Plan must be completed and submitted when:

  • your psychology or counselling is expected to exceed five treatment sessions
  • there has been a gap in treatment more than 12 months
  • you attend a new psychology or counselling clinic.

Only one Treatment Notification Plan is usually required during the life of the claim. All fields on the Treatment Notification Plan must be completed.

If reasonable additional psychology or counselling services are needed at the end of a treatment plan, your psychologist or counsellor must call your claims manager to discuss your progress and the need for more services.

Psychologists or counsellors should not submit multiple Treatment Notification Plans, a report or review plans unless Comcare specifically requests this be provided.

Extended consultations

Your psychologist or counsellor must get prior approval where there is reasonable justification for consultations to exceed 60 minutes.

Without prior approval, we can only fund a maximum of 60 minutes per consultation per day.

Request for extended consultations can be made on a Psychology or Counselling Extended Consultation Request form (PDF, 58.5 KB). This form is required in addition to the Psychology and Counselling Treatment notification plan (PDF, 128.2 KB) and Review Treatment Plans.

Significant gaps in treatment

A gap in treatment is when you have not received psychology or counselling services for more than 12 months.

Following a gap in treatment Comcare can fund psychology or counselling services after:

  • a Treatment Notification Plan has been completed and submitted
  • confirmation has been received that the treatment is related to your work-related injury.

Ongoing treatment

If you are receiving long-term psychology or counselling services, we may request a review of your treatment goals and progress.

We will write to your psychologist or counsellor and ask them to submit a Review Treatment Plan. This is done on a case by case basis.

We send the Review Treatment Plan form to your provider to complete.

Pharmacy

Our Pharmacy Policy (PDF, 105.0 KB) endorses safely prescribing medicines—especially high-risk medicines such as benzodiazepines and opiates.

In our Pharmacy Pricing Policy (PDF, 100.2 KB) we also clarify injured employees' entitlements to access the Pharmaceutical Benefits Scheme (PBS).


Page last reviewed: 03 December 2019
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Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 09 Aug 2020

https://www.comcare.gov.au/claims/supports-benefits/medical-treatment