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Workers retain the right to:
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.
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:
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:
There are no significant alterations in these areas to what was required before the recent legislative changes then:
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:
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.