Information for medical practitioners providing services to patients with an accepted compensation claim under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
Standards for medical practitioners
To provide services under the SRC Act, you must:
- be registered with the Australian Health Practitioners Regulation Agency (AHPRA)
- have no registration conditions that prohibit you from providing services
- meet Comcare's standards for all service providers.
Comcare endorses the Clinical Framework for the Delivery of Health Services which sets out principles for the delivery of health services to injured or ill employees.
Your role in an employee's rehabilitation
Medical practitioners play a vital role in the rehabilitation of employees. Your main goal is to help your patient safely stay at or return to work.
Your role is to:
- diagnose and assess illness, injury and health conditions
- assess work capacity and provide medical certification
- provide treatment
- refer them for specialist treatment
- provide advice on alternative duties or workplace modifications
- review proposed return to work plans to ensure duties suit capacity
- participate in return to work case conferences (if applicable)
- provide information for clinical reviews.
Providing a medical certificate
For Comcare to assess and accept a compensation claim, a medical certificate must be provided. A medical certificate must be completed by a legally qualified medical practitioner (LQMP). A LQMP is a general practitioner or specialist such as a surgeon or psychiatrist.
The medical certificate must provide a clear diagnosis and information about your patient’s work capacity.
For psychological illnesses, please ensure that DSM-5-TR or ICD-10 criteria are used in formulating a diagnosis.The certificate of capacity is Comcare’s preferred medical certificate for assessing an employee’s capacity for employment following a work-related injury or illness. It is used as a form of medical evidence.
Your patient’s Rehabilitation Case Manager (RCM) may contact you about your patient’s diagnosis and capacity for work. You can contact the RCM if you need more information about your patient’s workplace and the rehabilitation supports available.
Return to work case conferences
When working with an employee with a compensation claim, you may be asked to participate in a return to work case conference.
Return to work case conferences connect those involved in an employee's illness or injury to discuss and support their rehabilitation and recovery at work pathway.
Clinical reviews
A clinical review is often completed for Comcare managed claims to ensure that the treatment being requested is clinically justified.
As part of a review, a clinical panel member will assess information on an employee’s claim file. They may ask you to provide information and offer advice for treating an employee with a claim.
Independent medical examinations
Independent medical examinations may be conducted where additional medical information or specialist opinion is needed to support decision making and management of a claim. The independent medical examiner may contact you to discuss aspects of the employees’ condition or treatment.
Payments for services
Treatment payment rates
Rates for medical and allied health treatment outlines the upper fee limits for medical services.
Case conference participation payment
Comcare pays for case conference participation in line with the Australian Medical Association (AMA) rates (available to AMA members or by subscription).
Your invoice must include:
- the service provided
- general medical practitioner provider number
- fee charged or AMA item number.
Please note: Comcare will only pay for a case conference when a Comcare employee is present or if the case conference is requested by Comcare.
Invoicing and payment
If the employee’s claim is managed by Comcare, see Invoicing and payment for comprehensive information on how to receive payment, including what we require on your invoice.
If the employee’s claim is managed by a self-insured licensee, contact them for information about invoicing and payment.
Where necessary, you can seek payment directly from your patient. The employee can then seek reimbursement from their claims manager.