Treatment

An important aspect of early intervention is giving workers the support they need to receive treatment as soon as possible after a work related injury or illness. We encourage employers to start actively managing employees who are suffering from a work related injury or disease—in terms of their medical treatment and adjusting their work.

Treatment expenses

Comcare can’t reimburse a worker or employer for medical treatment expenses until a claim for compensation is accepted. Typically when liability for a claim is accepted under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act), Comcare reimburses the employee for medical treatment or therapeutic costs incurred from their date of injury.

Employer considerations

In most circumstances Comcare is able to reimburse an employer for reasonable treatment or therapeutic expenses incurred from the accepted date of injury, and prior to a workers’ compensation determination—once liability is accepted.

Before agreeing to pay medical expenses on behalf of the employee—and before the claim determination has been made—employers should consider the following:

• The employer is accepting there will be risk if Comcare denies liability—Comcare will not pay for treatment costs when a claim has been denied.
• Comcare will pay for pre-liability section 36 and section 37 costs (SRC Act)—whatever liability decision is made.
• Comcare will not pay for ‘fitness for duty’ medical examinations that are not medical ‘treatment’ but an assessment of an employee’s fitness for duty.
• Comcare's preferred certificate is the Certificate of Capacity because it supports employers to understand what the employee can do, rather than what they can't do.
• The legislation allows Comcare to reimburse treatment that is ‘reasonable’ and at a cost that is ‘appropriate’. Employers should be familiar with what is considered medical treatment under the SRC Act and the clinical framework for the delivery of health services that has been endorsed by Comcare. This means that:
• • before agreeing to pay for treatment or therapy, the employer makes sure the injured employee has a medical certificate recommending the treatment and there is a clear link with the condition for which a claim has been submitted (a medical certificate is not required before starting physiotherapy)
  • ‘reasonable’ treatment for physiotherapy and psychology is limited to five consecutive sessions only with limits on how long any one treatment session can last
• Comcare has scheduled rates for medical and allied health treatment. If the treatment is above this limit and the employer pays the full rate then they will be liable for the gap amount.