Understanding Coverage After Claim Approval

If your claim is accepted by WorkCover Queensland, you can expect coverage for medical and rehabilitation expenses related to your injury, provided they are deemed reasonable and medically necessary. This coverage includes:

1. Treatment by registered medical or allied health practitioners (such as doctors, physiotherapists, dentists, etc.).
2. Necessary medical items during your recovery, including dressings and medicines.
3. Equipment hire, such as crutches and wheelchairs.
4. Return-to-work services supporting your recovery.
5. Travel expenses associated with your treatment.

Coverage Limits: Most treatments have predetermined fees, as outlined in the Medical Table of Costs and the Allied Health Table of Costs. WorkCover will cover costs up to these amounts. If your provider charges more, you are responsible for the difference (gap).

Payment Process: Typically, your healthcare provider will send the invoice to WorkCover, and payments will be made directly to them. In some cases, you might be required to pay during treatment, and WorkCover will reimburse you if your claim is accepted and costs align with the table of costs.

Reimbursement Procedure: To receive reimbursement, provide your bank details (if not already done) and keep original receipts. Write your name and claim number on receipts and submit them through Worker Assist, online upload, fax, or mail.

Hospital Costs: WorkCover may cover private hospital fees under the following circumstances:

1. Non-elective hospitalisation for necessary treatment due to serious or life-threatening injuries, covered for up to four days (or more if agreed upon).
2. Elective hospitalisation for treatment agreed upon by you and WorkCover before hospitalization.
3. MRI scan referrals, which must be provided by a specialist.

Exclusions: Certain items are not covered, including treatments by non-registered practitioners (e.g., massage or acupuncture unless by a registered healthcare professional), specific travel expenses, and unauthorized hospital costs.

Responsibility for Costs: If WorkCover cannot cover your costs, it could be due to pre-existing conditions or other reasons, which will be explained. If your claim is not accepted, you are responsible for medical and rehabilitation expenses. Self-insured employers may have different processes.

Contact WorkCover: For inquiries or additional information about payments and support, contact WorkCover Queensland at 1300 362 128.