NSW workers’ compensation claims: I’ve been injured and my medical expenses are piling up. Help!

Everyone has the right to go to work each day, knowing they’ll come home safely. If you’ve been injured or become ill at work you may be entitled to make a claim for workers’ compensation to cover lost wages, medical and rehabilitation costs, retraining expenses or a lump sum payment for permanent injuries. There have been a lot of changes to arrangements in NSW for seeking workers’ compensation in recent years. You could be forgiven for being a little confused about where to start. After all, workers’ compensation laws and entitlements are already a little hard to keep up with because they vary between states and territories and may be known as WorkCover, CTP or WorkSafe. Compensation and benefits can vary greatly depending on your injury and on the law you’re covered by

If you’ve been injured at work in NSW, Littles has you covered. This blog explores what medical treatment, and other related expenses, you are entitled to claim.

What medical expenses can I claim?

If your worker’s compensation claim is accepted, you will commence receipt of payments of weekly compensation for loss of income along with any reasonable medical treatment expenses.

Your doctor will need to seek approval for any treatment you require. Additionally, your insurer may need you to attend an Independent Medical Examination in order that they can be satisfied that the treatment is reasonable and necessary.

The types of medical treatment (and aids) you may be entitled to includes (but are not limited to):

  • GP expenses
  • allied health services, such as physiotherapy
  • surgery
  • dental treatment
  • hospital expenses
  • ambulance expenses
  • rehabilitation expenses
  • prosthetics, glasses, walking aids and hearing aids

I’m seriously injured. How long is my medical treatment covered for?

Medical and related expenses will cease at different times depending on your level of impairment and the date you ceased to be entitled to weekly benefits. The connection between your level of impairment and your entitlement to medical treatment expenses is as follows:

  • if your whole person impairment is assessed between zero and 10 per cent or your permanent impairment has not been assessed, you are entitled to payment of reasonably necessary medical treatment expenses for two years from the date of your claim or two years after your weekly compensation payments cease, whichever is the later
  • if your whole person impairment is assessed between eleven per cent and 20 per cent, you are entitled to payment of reasonably necessary medical treatment expenses for five years from the date of your claim, or five years after your weekly compensation payments cease, whichever is the later
  • if your whole person impairment is assessed as being greater than 20 per cent, you are entitled to the payment of your reasonably necessary medical expenses for life.

My claim for medical expenses has been rejected. What can I do?

If the IME you were sent to by the insurer does not agree with your treating doctor’s (GP) view that you require certain treatment, the insurer will issue a dispute. Firstly, you need an IRO approved lawyer, who will obtain funding for you to see another IME to provide a further opinion as to whether the treatment is reasonable and necessary. The lawyer will also seek funding for a report from your treating doctor regarding the need for the treatment.

Once the reports are available, the lawyer will seek a review of the insurer’s decision and the insurer will have 14 days to issue its further decision, which may be to approve the treatment.

If the insurer maintains its decision to decline liability for payment of the treatment, your lawyer will obtain funding to refer your claim to the Personal Injury Commission who will decide whether to refer you to a medical assessor to resolve the dispute or whether the matter will be determined at an arbitration hearing. The dispute may resolve through settlement discussions prior to going to arbitration.

What other expenses may I be entitled to claim?

In addition to medical expenses, injured workers – or dependents of deceased workers – may also be able to claim for things like domestic assistance, such as cleaning, home maintenance and gardening; and travel expenses associated with travel to attend medical appointments.

Clearly, the workers’ compensation system can be complex, which is why it helps to seek quality legal advice as soon as possible. At Littles, we are experts in workplace injuries, and can help manage the process to ensure that you receive all appropriate entitlements and support. With Littles on your side, we can ensure that you get the fair treatment you deserve.

If your workers’ compensation claim has been rejected, or you would like to understand how to claim benefits to support you and your family while you are injured or ill, please get in touch for a no-obligation chat.

IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly.

Free advice and no upfront fees

Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.

The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice.

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles.

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