Treatments and Intensive Rehabilitation Assistance
Workers retain the right to:
- Choose their own doctor - Nominated Treatment Doctor (NTD) if a worker wishes to change NTD’s a written request must be made citing reasons - “acceptable” reasons include worker or doctor has moved locations and extensive travel involved, doctors retiring or unwell, Reasons such as poor rapport, doesn’t listen, won’t refer, may not be considered acceptable reasons by the insurer.
- Choose the therapist - i.e. physiotherapist, psychologist, chiropractor, however recommendations may be made from a rehabilitation provider to use one of their in house treatment providers. This should be discussed with the NTD first. All referrals must be made by the NTD and unless is a specific WorkCover guideline for that type of therapist –approval needs to be obtained prior to any assessment or treatment.
- Choose their own rehabilitation provider when their insurer or employer has instigated a referral to a rehabilitation provider.
Employers who have injured workers with more complex injuries, and / or do not have their own return to work coordinator may need to access an external rehabilitation provider. They can choose to do this themselves, or request a rehabilitation provider from their insurer. All insurers have their own “preferred providers” who have an agreement concerning how they manage claims and the cost structures that are used.
A worker may choose a provider of their own however, providing that provider is accredited with WorkCover NSW if they are not happy with the services of the provider chosen by the insurer or employer. It is necessary to put a request in writing to the insurer. The new alternative provider can usually assist in the process.
- Have travel costs reimbursed for travelling to and from treatment providers and to specialists they are sent to by the insurer or employer. Under the new legislation however insurers can refuse to pay for travel costs if the travel involved to the nominated treatment provider is deemed excessive. It is at the discression of insurers however to decide what is excessive.
- Workers medical expenses continue to be covered - i.e. costs for medications bandages appliances
- Support at home while convalescing - i.e. after surgery with such things as cleaning costs continue to be covered. Rehabilitation providers can and should be should be accessed to provide home assessments and recommendations concerning the type and level of support needed.
For Treatment Providers - Payment of medical and treatment expenses
There are some changes to the way treatment may be accessed by workers and the providers service reimbursed. A summary of the new legislation and relevant comments as it pertains to treatments is as follows:
- The worker’s employer is not liable under this section to pay the cost of any treatment or service (or related travel expenses) If the treatment or service is given or provided without the prior approval of the insurer (not including treatment provided within 48 hours of the injury happening and not including treatment or service that is exempt under the Workcover Guidelines from the requirement for prior insurer approval),
Several of the accredited Workcover para medical service providers - i.e. psychologists and physiotherapists have conditions imposed by Workcover Guidelines on the provision of treatment or services that appears to override this sweeping requirement of service providers. For example psychologists are NOT required to get formal approval for commencement of treatment after they have received a referral from the NTD, provided there is a valid claim for up to 6 treatment sessions. They are however, encouraged to notify the insurer of “commencement of treatment” and check there is valid claim. After the 6 sessions, a treatment plan must be lodged with the employer if additional sessions are required. If the insurer does not respond then approval is considered to be given. The recent legislative changes have not changed this arrangement. Similar arrangements occur for physiotherapists and chiropractors in that:
- The treatment or service is given or provided by a person who is not appropriately qualified to give or provide the treatment or service, or
- The treatment or service is not given or provided in accordance with any conditions imposed by the Workcover Guidelines on the giving or providing of the treatment or service, or
- The treatment is given or provided by a health practitioner whose registration as a health practitioner under any relevant law is limited or subject to any condition imposed as a result of a disciplinary process, or who is suspended or disqualified from practice.
There are no significant alterations in these areas to what was required before the recent legislative changes then:
- The worker’s employer is not liable under this section to pay travel expenses related to any treatment or service if the treatment or service is given or provided at a location that necessitates more travel than is reasonably necessary to obtain the treatment or service.
Although travel costs have always been monitored and challenges made about what is “reasonably necessary” this issue has now been revisited. It is anticipated that there will be challenges to the enforcement concerning issues of “reasonably necessary” , particularly in situations such as psychological treatment after an injured worker or therapist has moved locations - particularly where therapist / patient relationship is critical for outcomes and the changing to a new unknown therapist is requested and:
- Workcover guidelines may specify things such as qualifications, limiting the amount and conditions for giving treatments - e.g billing the insurer for conference attendance irrespective of the time involved in the conference - usually capped at 1 hour.
There is evidence that there is a crackdown on travelling to and from case conferences without prior approval being gained in writing by the insurer. This can prove problematic when the conference is organised by a 3rd party’s such as a treatment provider who requests the conference and attendance of particular professionals. The insurer may at later date choose not to pay for the travel involved to and from the conference venue from the professionals usual Workplace unless they have given their written approval in advance.
