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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 psychologists, physiotherapists, occupational therapists, osteopaths and chiropractors.

Standards for health practitioners

Medical practitioners, pharmacists, dentists, nurses and most allied health professionals are required to be registered with the Australian Health Practitioners Regulation Agency (AHPRA) in order to provide services. You can check the registration status of your health provider on AHPRA’s register of practitioners .

For allied health professionals not covered by AHPRA, Comcare strongly recommends choosing an allied health provider with relevant membership to an appropriate professional body.

By choosing a provider with current AHPRA registration or membership to a professional body, you can be confident that the provider has the training and competencies to deliver high quality, individualised services.

More information on standards for health practitioners is available on Comcare’s service provider pages.

How to request approval for treatment

To request medical treatment, discuss your treatment needs and submit a claim form or request 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 regarding your treatment claim or request. In some instances the claims manager may need more information. If your claims manager needs more information, they will write to you or your medical provider.
  5. Once you complete the treatment, submit the claim 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:

    Medical Services Claim form (PDF, 95.9 KB), or
    Exercise as Medical Treatment Claim form (PDF, 114.0 KB) for exercise you require for medical treatment under section 16 of the Safety, Rehabilitation and Compensation Act 1988 (SRC Act). Support to exercise for general health, fitness or psychological wellbeing is not medical treatment under the SRC Act and is not compensable.
  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.

Medical examinations

Information Regarding your Attendance at a Medical Centre factsheet (PDF, 96.0 KB) provides information regarding your attendance at a medical centre and sets out your rights and obligations in relation to your examination.

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 Plan (PDF, 147.8 KB) for you.

A Treatment 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.

If reasonable additional physiotherapy services are needed at the end of a treatment plan, your physiotherapist must call your claims manager to discuss the need for further services and submit a subsequent Treatment Plan. Any period of treatment should be covered by a Treatment Plan.

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. A Physiotherapist from Comcare’s Clinical Panel may also contact your treating Physiotherapist to discuss your treatment.

Psychology treatment

Psychology treatment overview

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

Comcare can fund the reasonable cost of psychology 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.

Starting treatment

Comcare can fund an initial five sessions of psychology. The sessions must not exceed 60 minutes. After this, your psychologist needs to complete and submit a Psychology Treatment Plan (PDF, 161.9 KB).

A Treatment Plan must be completed and submitted when:

  • your psychology 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.

If reasonable additional psychology services are needed at the end of a treatment plan, your psychologist must call your claims manager to discuss your progress and the need for more services, and submit a subsequent Treatment Plan. Any period of treatment should be covered by a Treatment Plan.

Extended consultations

Your psychologist 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 Extended Consultation Request form (PDF, 125.0 KB). This form is required in addition to the Psychology Treatment Plan (PDF, 161.9 KB).

Significant gaps in treatment

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

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

  • a Treatment 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 services, we may request a review of your treatment goals and progress. A Psychologist from Comcare’s Clinical Panel may also contact your treating Psychologist to discuss your treatment.

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).

If you have a complaint

If you are unhappy with the way a service has been delivered, or with how you have been treated, you have a right to complain and have your concerns addressed.

You can:

  • Raise the concerns with the health practitioner or the medical practice providing you treatment, if you feel comfortable to do so.
  • Change to another health practitioner (this may require another referral from your legally qualified medical practitioner) if you do not feel comfortable raising your concerns or feel your concerns have not been addressed.
  • Raise serious or ongoing concerns about a provider’s behaviour with AHPRA or the providers’ professional registration body.
Page last reviewed: 23 February 2023

Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 21 Apr 2024

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