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Home » Injured Workers » Injury Management- What is happening and When? » Treatment Services That Don’t Require Prior Approval

Treatment Services That Don’t Require Prior Approval

 

 

Exemptions

 

 

The following treatments are exempt from the requirement for prior insurer approval. (Note: These exemptions only apply where provisional liability for medical expenses or liability for a claim has been accepted).

  

 3.2.1 Nominated treating doctor

 

Any consultation with the nominated treating doctor in relation to the injury claimed except for consultations for mental health treatment items AA905 and AA910 in current Australian Medical Association List of Medical Services and Fees.

 

 3.2.2 Specialist medical practitioner

 

The first consultation for the injury with a specialist medical practitioner, on referral by the worker’s nominated treating doctor.

 

 

 3.2.3 Pharmacy

 

3.2.3.1 Pharmacy items prescribed by the nominated treating doctor or specialist medical practitioner for the injury in the first 3 weeks post injury, to a maximum of $500.

 

3.2.3.2 Pharmacy items excluded from the Pharmaceutical Benefits Schedule to a maximum amount of $100.

 

 3.2.4 X-Ray

All plain x-rays performed on referral from the nominated treating doctoror specialist medical practitioner in relation to the injury claimed and provided within one week of injury.

 

 3.2.5 Public hospital

 

Any services provided in public hospitals that are provided by or consequent upon presentation at the hospital’s emergency department for the injury claimed that is within one month of the date of injury.

 

 

 3.2.6 Physiotherapy, Osteopathy or Chiropractic treatment

 

3.2.6.1 The initial consultation and up to a further seven treatment sessions provided by a registered practitioner where:

a) The injured worker has not previously received treatment for the injury claimed, or

 

b) The treatment resumes with the same practitioner within a three month period from the last treatment and less than eight treatment sessions were provided originally.

 

c) The treatment resumes with the same practitioner within a three month period under a previously approved planand deemed as the same episode of care.

  

3.2.6.2 The initial assessment for a new episode of care where a worker ceased treatment more than three months previously and returns for additional treatment for the same injury. The registered practitioner cannot utilise any remaining treatment sessions that may have been approved under the previous  episode of care.

 

 

 

3.2.7 Psychology treatment or counselling

  

3.2.7.1 The initial consultation and up to a further five treatment or counselling sessions provided by a WorkCover approved practitioner where:  

a) The injured worker has not previously received treatment/counselling for the injury claimed, or

 

b) The treatment/counselling resumes with the same practitioner within a three month period from the last treatment and less than six treatment sessions were provided originally.

 

c) The treatment/counselling resumes with the same practitioner within a three month period under a previously approved plan and deemed as the same episode of care.

 

3.2.7.2 The initial assessment for a new episode of care where a worker ceased treatment/counselling more than three months previously and returns for additional treatment/counselling for the same injury. The registered practitioner cannot utilise any remaining treatment/counselling sessions that may have been approved under the previous episode of care.

 

 

3.2.7.3 The preconditions to be met before the exemption will apply are:

 

a) The psychologist must be WorkCover approved and

 

b) The injured worker’s nominated treating doctor or treating specialist medical practitioner who is a psychiatrist must make the referral for treatment.

 

 

 

3.2.8 Remedial Massage

 

 

3.2.8.1 No more than 5 sessions of remedial massage, where there has been no previous remedial massage therapy for the injury claimed.

 

3.2.8.2 The precondition to be met before the exemption applies is:

 

a) The remedial massage therapist must be WorkCover approved.

 

  

3.2.9 Hearing needs assessment

 
3.2.9.1 The initial hearing needs assessment only.


3.2.9.2 The preconditions to be met before the exemption will apply are:


a) The hearing service provider must be WorkCover approved and


b) The injured worker’s nominated treating doctor is to have referred the worker to a treating specialist medical practitioner who is an ear, nose and throat physician to determine that the hearing loss is work-related and
that there is binaural hearing loss of 6% or more. The ENT makes the referral for treatment.



 


 

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