WorkCover claims, and your GP

In my experience WorkCover claims tend to generate confusion and anxiety. This is what patients need to know:

  1. By law the worker alone determines whether to lodge a claim after an injury. The employer may attempt to influence the worker in one direction, or another. Your GP may offer some advice, but the final decision rests with the worker.
  2. Reimbursement of treatment expenses, and income compensation, are independent processes. For income compensation due to temporary debilitation, a certificate of capacity from your GP is required to start the claim process. This certificate merely describes the patient’s current functional capacity. For the partially incapacitated worker, whether they end up not working, or with modified duties, depends on the employer’s response.
  3. The initial certificate covers only the first 2 weeks after the injury. Subsequent ones can cover up to 4 weeks; however for scenarios which continue to evolve, more frequent reviews will be needed. Once fully recovered, a final certificate indicating the full return to capacity is issued.
  4. The claim may take weeks to be approved — or not. This is a difficult period for patients, as they require investigations and treatments immediately. However since the claim is not yet approved there is no account to claim against. And Medicare will not rebate WorkCover cases so there is a vacuum of subsidies. This means the patient ends up paying out of pocket for expensive consultations, scans, and therapy sessions — until such time the claim is approved.
  5. And if not the patient ends up with a total bill of not uncommonly 4 figures. However if the worker decides not to appeal the claim, the receipts can be submitted for Medicare rebates at that stage.
  6. For the above reasons I generally recommend patients to lodge claims only if they can accept the administrative and financial burden, which is less often than is ideal.

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