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Medical practitioners

For: Service providers Information seekers

Information for medical practitioners, dentists or nurses who provide services to patients with an accepted claim under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).


What are medical services

Medical services are delivered by legally qualified medical practitioners (LQMP) working as a general practitioner or a specialist. Medical practitioners play a vital role in the rehabilitation and return to work of employees.

Standards for medical practitioners, dentists and nurses

Medical practitioners, dentists or nurses providing services under the SRC Act must be registered with the Australian Health Practitioners Regulation Agency (AHPRA). Your registration should have no conditions that prohibit you from providing services and you must meet AHPRA's registration standards. You must also meet Comcare's standards for all service providers.

Comcare endorses the Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB). The framework outlines a set of guiding principles for the delivery of health services to injured or ill employees.

Your role in an employee's rehabilitation

The main goal for a medical practitioner working with a patient who has a work-related injury or illness is to help them safely stay at or return to work, health and independence as soon as possible.

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
  • provide information for clinical reviews.

Diagnosis

For Comcare to assess and accept a claim, we must receive a clear diagnosis from an LQMP such as a general practitioner, or specialist such as a surgeon, psychiatrist or dentist.

Note: For certain first responders with post-traumatic stress disorder (PTSD), a diagnosis from an LQMP or a psychologist in accordance with the diagnostic criteria in the Diagnostic And Statistical Manual of Mental Disorders, fifth edition text revision (DSM-5-TR) or later edition, can be used.

As the treating medical practitioner, our claims managers or injury managers may contact you if they need more information about your patient's injury or illness. Contact is usually in writing although in some cases, a phone call may be enough to clarify an issue.

You can also contact the claims or injury manager if there is something you need to discuss about your patient's claim with us.

Certifying work capacity

When assessing capacity, it is important to focus on what your patient can do, not what they can’t do, at work. This information is included in the medical certificate, which is a form of medical evidence. Comcare’s preferred medical certificate is the certificate of capacity.

Claims managers will generally not accept backdated certificates of capacity.

Return to work case conferences

You may be required to be involved in a return to work case conference.

Return to work case conferences connect professionals and others involved in an employee's illness or injury to discuss and support their rehabilitation and return to work process.

Clinical reviews

clinical review is an internal claims management process for Comcare managed claims. It is a cooperative and collaborative process between the treating healthcare providers and members of the clinical panel.

The focus of a clinical review is to make sure treatment is clinically justified. As part of a review, the clinical panel assesses information on an employee’s claim file, asks medical practitioners to provide information and offers advice to health professionals treating an employee with a claim.

Independent medical examinations

Independent medical examinations may be conducted where additional medical information or specialist opinion is required to support the decision making and management of the claim. As a treating health practitioner, you may be contacted by the independent medical examiner to discuss aspects of the employees’ condition or treatment.

Payments for services

Rates of payment

Rates for medical and allied health treatment outlines the upper fee limits for medical services.

For case conference participation

Comcare uses the Australian Medical Association (AMA) rates (available to AMA members or by subscription) to pay invoices related to participation in a case conference.

Invoices for participation in a return-to-work case conference must include information on:

  • the service provided, namely return to work case conference
  • general medical practitioner provider number
  • fee charged or AMA item number.

How providers are paid

1. Through the claims manager

If your employees claim is managed by Comcare, see Invoicing and payment for comprehensive information on how you can be paid by Comcare, including what we require on your invoice.

If the employee’s claim is managed by a self-insured licensee, you should work directly with the licensee.

2. By the employee

Where necessary, health service providers can seek payment directly from the employee receiving the service. The employee can then seek reimbursement from their claims manager.

More information

We have collated a suite of resources specifically to support health practitioners involved in a patient's workers' compensation claim.

Page last reviewed: 12 March 2024

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

Date printed 21 Apr 2024

https://www.comcare.gov.au/service-providers/medical-allied-health/medical-practitioners