Medical, hospital and rehabilitation expenses

You may be eligible for all or some medical treatments and services.

Medical or related treatment

Medical or related treatment includes:

  • treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, accredited exercise physiologists, massage therapists and other allied health practitioners
  • provision of artificial aids
  • domestic assistance services
  • nursing, medical and medicine supplies (provided outside of hospital treatment)

The insurer will only approve and pay expenses for reasonably necessary treatment. Most treatment requires prior approval, however some treatment does not require prior approval.

Treatment which is exempt from pre-approval is as follows:

  • treatment provided in the first 48 hours following the injury
  • any consultation or case conference for the injury with the nominated treating doctor, apart from telehealth and home visits and any treatment during the consultation for the injury within one month of the date of injury.
  • any consultation and treatment with a medical specialist, if referred by the nominated treating doctor, during the consultation within 3 months of the date of injury.
  • X-rays within two weeks of date of injury.
  • ultrasound, CT Scan, MRI, within three months of date of injury if referred to or by a medical specialist
  • any services provided in the emergency department of a public hospital and any services after receiving treatment at the public hospital emergency department for the injury, within 1 month of the date of injury
  • prescription and over the counter medication prescribed by the nominated treating doctor or medical specialist within 1 month of the date of injury or after 1 month of the date of injury only if prescribed through the Pharmaceutical Benefits Scheme

SIRA approved physical treatment practitioners (physiotherapist, osteopath, chiropractor, accredited exercise physiologist)

  • up to eight consultations if the injury was not previously treated and treatment starts within three months of the date of injury
  • up to three consultations if the injury was not previously treated and treatment starts over three months after the date of injury
  • up to eight consultations per Allied health recovery request (AHRR) if the same practitioner is continuing treatment within three months of the date of injury and:
    • the practitioner sent an AHRR to the insurer, and
    • the insurer did not respond within five working days of receiving the AHRR
  • one consultation with the same practitioner if the practitioner previously treated the injury over three months ago: this is a new episode of care
  • one consultation with a different practitioner if the injury was previously treated
  • up to two hours per practitioner for case conferencing that complies with the applicable fees order
  • up to $100 per claim for reasonable incidental expenses for items the worker uses independently (such as strapping tape, theraband, exercise putty, disposable electrodes and walking sticks)

    Notes:

  • consultations with an accredited exercise physiologist require a referral from a medical practitioner
  • all treatments exclude home visits, telehealth and practitioner travel
  • list of SIRA approved practitioners

SIRA approved psychologist or counsellor

  • up to eight consultations if a psychologist or counsellor has not previously treated the injury and treatment starts within three months of the date of injury
  • up to three consultations if a psychologist or counsellor has not previously treated the injury and treatment starts over three months after the date of injury
  • up to eight consultations per Allied health recovery request (AHRR) if the same practitioner is continuing treatment within three months of the date of injury and:
    • the practitioner sent an AHRR to the insurer, and
    • the insurer did not respond within five working days of receiving the AHRR
  • one consultation with the same psychologist or counsellor if the practitioner previously treated the injury over three months ago: this is a new episode of care
  • one consultation with a different psychologist or counsellor if the injury was previously treated
  • up to two hours per practitioner for case conferencing that complies with the applicable fees order
  • up to $100 per claim for reasonable incidental expenses for items the worker uses independently (such as relaxation CDs and self-help books)

    Notes:

  • these consultations require a referral from a medical practitioner
  • all treatments exclude home visits, telehealth and practitioner travel
  • there is no exemption from pre-approval for remedial massage

It is important to read the full details, including the time frames for claiming expenses in the guidelines for claiming workers compensation.

With the introduction of the SIRA Workers Compensation Regulation Guideline for approval of treating allied health practitioners on 1 January 2016, allied health practitioners in certain disciplines (including accredited exercise physiologists, chiropractors, counsellors, osteopaths, physiotherapists and psychologists) are required to be SIRA Workers Compensation approved before they are able to treat workers in the NSW workers compensation system.

Note: All workers are entitled to at least two years of medical benefits from when weekly payments stop being payable or from the date of claim if no weekly payments are made, whichever is later. Further timeframes are: five years for those with 11-20 per cent permanent impairment or for life for those with greater than 20 per cent permanent impairment.

Please refer to the Insurance Reforms website for more information.

Hospital treatment

Hospital treatment includes treatment at public and private hospitals and/or rehabilitation centres.

Ambulance services

Ambulance services include emergency, non-emergency and inter-hospital transfers provided by the Ambulance Service of NSW.

Workplace rehabilitation services

Workplace rehabilitation services include:

  • return to work and case management
  • vocational, functional and workplace assessments
  • job analysis and modification
  • identification of suitable employment
  • worker retraining and placement in suitable employment

These services are provided by approved workplace rehabilitation providers.

Travel expenses

To claim for payment for travel to attend medical, hospital and rehabilitation appointments, the worker will need to keep:

  • a record of the mileage if the worker uses his/her car
  • receipts for public transport

The maximum amount payable for private car travel associated with attending medical, hospital and rehabilitation appointments is currently $0.55 per kilometre. This amount is reviewed every 12 months.

Further information

The SIRA workers compensation SIRA workers compensation benefits guide contains the past and current benefits payable for medical, hospital and rehabilitation expenses. Call SIRA on 13 10 50 for more information about medical, hospital and rehabilitation expenses.