Frequently asked questions about workcover and work injuries
1. Is my patient entitled to WorkCover?
Yes, if they have been injured at work in Victoria.(This blog/website is covers the Victorian legislation).
WorkCover is a no-fault system, covering people who are injured at work regardless of how it occurs. Even if it does not occur at your patient’s normal workplace, it can still be considered a ‘work injury’ (i.e. during travel related to work, at another place where the worker was supposed to be etc).
Work injuries can be caused by a particular incident (for example, a fall at work), or over time (for example, repetitive injuries (i.e Carpal Tunnel), heavy work over time, or even stress). Injuries can thus be both physical and psychological.
If your patient is unsure of their rights, they can get free, obligation-free advice by calling a workcover lawyer such as Shine Lawyers. More information about WorkCover and entitlements can be found in our frequently asked questions and most frequently asked questions.
2. How can my patient access WorkCover?
The injured person needs to complete a WorkCover claim form, which can be obtained from their employer, the Victorian WorkCover Authority (WorkSafe), or from a local post office. This claim should be lodged as soon as possible after suffering the injury.
He or she needs to give the completed form to their employer, along with any receipts for reimbursement. If the worker wants to claim weekly payments, they also need to provide a WorkCover Certificate of Capacity completed by his or her treating doctor, which is generally the GP, surgeon or psychiatrist.
3. How should I fill out the Certificate of Capacity?
The first Certificate of Capacity should be for 14 days, and all subsequent Certificates for up to 28 days. You can back date a Certificate of Capacity for up to 3 months in the past, as long as you were treating patient during that period, and you certify that the patient was incapacitated during that period.
If you consider that your patient is able to work, but only with restrictions due to their work-related injury, tick the box “fit for modified duties”. Then, be specific about his or her restrictions. For example – “no lifting above 5 kilograms, no bending”, or “no classroom teaching”, or “fit for 4 hours per day, 4 days per week”. The employer then has an obligation to try to provide duties consistent with those certificates.
If your patient is unfit for their pre-injury duties, but can perform alternative work duties, they will not be entitled to weekly payments of compensation beyond 130 weeks.
If you consider that your patient is totally incapacitated for all work by reason of their work-related injuries, tick the box “unfit for all duties”.
An injured worker is only entitled to weekly payments of compensation after 130 weeks if the WorkCover or a Medical Panel determines that they are totally unfit for all duties, due to the work injury, and this is likely to continue indefinitely.
4. What benefits can WorkCover provide?
Payment of ‘reasonable’ medical and like expenses
- Weekly payments of income compensation
- Travel expenses to attend medical appointments/treatments; taxi transport; home help; home and car modification; appliances; psychology/counseling; physiotherapy; massage etc.
- A once-off ‘impairment benefit’ lump sum if the injury is considered permanent (in Victoria you need a 10% total body impairment or for injuries after 2003 a 5% upper limb, spine or lower limb injury).
- If your client has a serious injury caused by negligence at work or while performing work duties, they may be able to bring a common law claim for lost earnings, and pain and suffering damages.
5. What medical expenses will WorkCover pay for?
WorkCover will pay for the ‘reasonable medical and like expenses’ needed as a result of a work-related injury. This can include GP visits, surgery and medication, as well as a range of approved services including dentistry, massage, hydrotherapy, physiotherapy and even gym memberships.
In addition, upon request from a medical practitioner, personal and household services can be provided by WorkCover, including household help, orthopaedic aids, appliances and even gardening services.
If your patient reasonably requires treatment or care that WorkCover has declined to pay for, the injured worker can appeal the decision to Conciliation (ACCS).Many decisions are overturned at Conciliation.
6. When do I need to write a report for WorkCover or the Accident Compensation Conciliation Service? And how do I charge my fee?
From time to time, WorkCover will request medical reports from patient’s treating practitioners. If your patient takes a matter to conciliation, the ACCS (Accident Compensation Conciliation Service) may also request a report directly from you. Sometimes, your patient will ask for your written opinion to take to the Conciliation.
Your tax invoice can generally be sent to the workcover insurer requesting your report for pre-payment.
Also see Checklist for preparing a medical report (Source: Advicelineinjurylawyers)
7. How do I write a report for solicitors? And how do I charge my fee?
To investigate a “clients’” (injured worker) potential entitlements, lawyers often write to doctors and health care providers directly to request medical reports.
They will usually ask specific questions in their letter(s) – and it is important for your patient’s claim that you address each separate question. If you have any queries at all in relation to a report request that you have received, you should contact the lawyer.
Most lawyers are happy to pre-pay for the report if a tax invoice is provided to their office. They also understand that medical practitioners are busy, and greatly appreciate the time and effort that you spend in preparing these reports. Please note that whilst the lawyer will pay for the report, ultimately the client (the injured worker) will have to pay for it. For example, if you think that you cannot help the injured worker, please say so first – this will save us (workcovervictims) money that we don’t have!
Please also see Checklist for preparing lawyer’s reports (source: Advicelineinjurylawyers)
8. Why does my patient have to see ‘Independent Medical Examiners’?
WorkCover will periodically (although in some cases outrageously often) have your patient examined by so called independent specialists (Independent Medical Examiners – IMEs – who happen to be paid for by workcover insurance companies) to assess whether they can return to work, and what treatment is reasonable.
An IME may (often) have an opinion which is different from yours. While the IME may be a specialist in their field, as a treating doctor or medical practitioner, you may have better knowledge or understanding of your patient. If you disagree with the report of an IME, it is helpful to clearly state your opinion and reasoning in your own medical reports.
Although these appointments can be stressful for patients, it is important that your patient attends appointments with IMEs, because WorkCover can cut off their compensation payments if they do not cooperate.
It is very important that you know that 9 out of 10 of these so called IME’s are hired by the workcover insurer to provide the insurance company with a good excuse not to make good on it’s “contract” or obligation, in other words NOT to pay a “benefit”. Sometimes it’s about not paying for much needed surgery or an MRI, other times it’s to cut off the patient’s physiotherapy treatments or psychology sessions. The insurers will most often send your patient to the most inappropriate IME, such as to a “general surgeon” or an “occupational physician” when your patient suffers from a very severe and complex purely orthopeadic problem. Surgical opinions will be sought by non-specialists and there have been cases whereby physically unfit-for-work patients have been repeatedly sent to psychiatrists in an attempt to have them certified fit for work. You also need to remember that the workcover insurers are extremely selective in forwarding ‘relevant material’ to the IME, for example when a surgical opinion is requested they will send a psychiatric report, but not one surgical report (even though the patient may have had 6 operations), no MRIs, X-rays etc. Your support is therefore invaluable as an IME can be the death of a genuinely injured worker’s ‘claim’.
9. Problems with WorkCover – what can you do to help your patient?
Dealing with WorkCover can be extremely frustrating, not only for you but also for your patient. If your patient disagrees with a WorkCover decision, they can request Conciliation. Conciliation can also be requested where an insurance agent has failed to respond to a request within 60 days. For example if you requested an MRI or surgery or any other test/service/treatment.
Request for Conciliation forms can be obtained from WorkCover, or from the ACCS website .
If there is a medical question in dispute the ACCS (Accident Compensation Conciliation Service) may request a report from you. Writing a clear and supportive report prior to any conciliation date is of invaluable assistance to your patient.
10. Do I have to provide my patient records?
Under the Health Records Act 2001 (Vic), individuals have a right of access to their health information. You are required to provide a copy of patient records upon a valid request from the patient or their authorised representative.
You are entitled to charge a fee for the provision of these records. The maximum fee allowed to be charged is specified in the Health Records Regulations 2002.
For further information about your obligations regarding the provision of health information to individuals, refer to the website of the Health Services Commissioner.
Useful information and guides for medical practitioners have been developed by the ANF
Medical Practitioners can request occupational rehabilitation services
The Accident Compensation Act 1985 (section 5) states that medical practitioners can request occupational rehabilitation services. An example/draft letter has been provided to assist you in requesting Occupational Rehabilitation Services which is to be addressed to the work cover Agent. (This guide was developed by the Australian Nurses federation).