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Workcover Medical Expenses

If you have had an injury at work, in accordance with section 60 of the Workers Compensation Act 1987, the worker’s compensation insurer is required to pay all “reasonably necessary” medical expenses.

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Claiming medical expenses can include the below:

1. Medical and related treatment includes:

  • Treatment by medical practitioners, physiotherapist, chiropractors, osteopaths, psychologists, counsellors, exercise psychologists, remedial massage therapists and other allied health practitioners.
  • Provision of artificial aids.
  • Domestic assistance services.
  • Nursing, medical and medicine supplies (provided outside of hospital treatment).

2. Hospital treatment

Hospital treatment includes treatment at public and private hospitals and/or rehabilitation centres.

3. Ambulance service includes emergency, non-emergency and inter hospital transfers provided by the Ambulance Service of NSW.

4. Work place rehabilitation services include:

  • Return to work in case management.
  • Vocational, functional and work place assessments.
  • Job analysis and modification.
  • Identification of suitable employment.
  • Worker retraining and placement in suitable employment.

5. Travel expenses can be claimed. To claim for payment for travel to attend medical, hospital and rehabilitation appointments, the worker will need to keep:

  • A record of the mileage if the worker used his or her car; and/or
  • Receipts for public transport.

The maximum amount payable for private car travel associated with attending medical expenses is currently $0.55 per kilometre.

Would you like assistance with your claim?

Complete our free, no obligation confidential case assessment form and we’ll get back to you within 24 hours.

Alternatively, we are available to talk by phone and email. Please contact our experienced accredited specialist personal injury lawyers to find out how we can help.

No Win No Fee

You won’t be required to pay any fees until we win your case.

Industry Experts

We’re industry experts with over 20 years of experience.

Maximum Compensation

Our team of expert injury lawyers will help you get maximum compensation.

Jude M.
03:54 21 Feb 25
I rang Mr Matthew Garling on a matter, and Matthew gave me his time and honest advice from goodwill. Matthew is a very honest, good man of integrity who went beyond the call of duty. I would highly... recommend Matthew and his company.read more
Pouya Zadbar T.
01:36 15 Feb 25
Garling and Co were very helpful and did their best to get the most payout for my mothers workers compensation claim. We were very happy with their patience and understanding as this was a long and... trying process with the insurance. I Would definitely recommend their services.read more
Don T.
05:59 13 Feb 25
I had an occupational accident for 2 years and after the surgery for a whole year there was no good result and my body was in so much pain that I could not return to work. Everyone told me to find a... lawyer immediately, I did not know which lawyer could help me so I searched on Google. After searching I found that many clients were very satisfied with Garling & Co, so I texted Garling & Co. They immediately called back and asked if I felt pain and could not come to the office, they would come to see me but I replied that I could come. And the legal journey started from there. I met Mr. Garling who was about my age but very enthusiastic and dedicated and he explained and advised me in a way that I could understand all the questions and I agreed with him very much, then he handed over my case to Ms. Allison to contact me. Everything went very well according to his arrangements from the first step to the last step. Until the last day, he explained how the negotiation was going and I understood the whole story. I did not ask for too much and the number I gave was quickly agreed to avoid lengthy legal headaches. In total, after 4 years of the accident and almost 2 years with the help of Garling & Co, everything was resolved happily for all parties. Once again, I thank Mr. Garling, Ms. Allison and everyone at Garling & Co for helping me, they are wonderful and I hope they will continue their good work helping people who need legal help like I need help. Thank you very much Garling & Co.read more
Pedro M.
04:26 11 Feb 25
Thank you so much for all the help and support this past years.I recommend it to anyone who needs help.Thanks again and all the best for the Garling & Co team and a special thanks to Kerry Byrnes.
Ron J.
03:49 11 Feb 25
I had an overall good experience with Garling and Co. I was the victim of a major motorvehicle accident in April 2021. There were a few complications in my case including me having to move overseas... for 2 years temporarily during the progression of my claim and original lawyer from Garling that handled my case leaving the firm. The move overseas resulted in the insurer cutting off my income replacement, which lasted for 9 months, which as you can imagine created a major financial strain on the family On both these occasions, Garling worked to get a good result. They fought in front of the NSW Panel, and got a reported decision that states that all Permanent Residents and Citizens of Australia have the right to be paid income replacement even when overseas, during an accident claim under CTP cover. They also worked very hard in the face of a typically uncooperative and obstructive insurer to progress my claim over the last (almost 4 years) and the replacement lawyer Kerry Burns has done amazing work, with care, empathy and professionalism. I've had a good experience with them!read more
Sandra C.
03:27 06 Feb 25
Garling & Co Lawyers were professional from start to finish. They made me feel like I was as important to them as all their clients. Emma Perkins and her team went over and above in all aspects to... exceed my expectations. Highly recommended.read more
kokomo U.
01:38 15 Jan 25
Such a difficult time for me and so grateful to have alison and Mathews help...knowing I could trust in their knowledge, along with the understanding and compassion I received helped make a trying... time easier to navigate. Thankyou guys, would highly recommendread more
Sam H.
09:47 17 Dec 24
Very knowledgeable, explains everything very clearly and highly recommend.
Rachel R.
09:13 17 Nov 24
Although a long journey, the team at Garling & Co Lawyers have been amazing. They are thorough and clear with the processes and the expectations. It is a pleasure dealing with Emma and Rebecca. They... take all the weight off our shoulders when it comes to all the legal stuff and they make us feel comfortable and confident in their ability to look after us.read more
Angie & Brian M.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more

Find out more about Workers Compensation

Frequently Asked Questions

1. What is “reasonably necessary” medical treatment?

The insurer is required to pay “reasonably necessary” medical expenses. In determining what treatment is reasonably necessary, the insurer should have regard to:

  • The appropriateness of the treatment.
  • The availability of alternative treatment.
  • The cost of the treatment.
  • The actual potential effectiveness of the treatment.
  • The acceptance by medical experts of the treatment as being appropriate and likely to be effect.

The term has also been defined to mean “any necessity for relevant treatment which results from the injury where its purpose and potential effect is to alleviate the consequence of injury”.

Often this test is confused to mean that the treatment must be reasonable and necessary. This is incorrect. That is a much more demanding test.

If the treatment is such that its potential effect is to alleviate the consequence of injury, then it will be “reasonably necessary”

2. Is pre-approval necessary?

Section 60 (2A) of the Workers Compensation Act states that the insurer is not liable to pay for the cost of medical treatment without prior approval of the insurer.

However, there are several exceptions where no prior approval is required and they include the following:

  • Any treatment provided within 48 hours of the injury.
  • Attending a nominating treating doctor for a consultation or to obtain a medical certificate.
  • The first consultation with a specialist medical practitioner on referral by the nominated treating doctor.
  • All plain x-rays performed on referral from a nominated treating doctor or specialist medical practitioner.
  • Any service provided in a public hospital on presentation to an emergency department.
  • In relation to physiotherapy, osteopathic or chiropractic treatment, the initial consultation and up to a further 7 treatment sessions provided the practitioner is registered and the injured worker has not previously received such treatment for the injury claimed.
  • Pharmacy items prescribed by the nominating treating doctor within the first 3 weeks’ post injury up to a maximum of $500.00.
  • For any psychological treatment or counselling, the initial consultation and up to a further 5 treatment or counselling sessions where the counsellor is WorkCover approved and the worker has not previously received such counselling.
  • Payment of up to 5 sessions of remedial massage however the remedial massage therapist must be WorkCover approved.
  • In relation to a hearing needs assessment, the initial hearing needs assessment as long as such assessment was referred by the nominated treating doctor or treating specialist.
  • The Workers Compensation Commission or a registrar orders the insurer to pay for treatment expenses.

When you request pre-approval from the insurer, the insurer has a period of 21 days to respond to your request. If the insurer does not respond within 21 days, you can make a complaint to the WorkCover independent Review Office (WIRO).

If the treatment has been pre-approved and receipts have been sent to the insurer for reimbursement, the insurer must reimburse you within seven days of receiving your expenses receipts.

3. For how long does the insurer pay my medical expenses?

The period the insurer is responsible for paying reasonably necessary medical treatment differs depending on your assessment of whole person impairment (WPI):

  • 10% WPI or less: payment of medical expenses will cease 2 years from the date of the claim was made or from the date that weekly payments cease (whichever occurs later).
  • 11% to 20% WPI: payment of medical expenses will cease 5 years from the date that the claim was made or from the date that weekly payments cease (whichever occurs later).
  • 21% or more WPI: payment of medical expenses are payable for the remainder of the injured workers life.

4. What do I do if the insurer declines my treatment?

The insurer may decline to pay for your medical expenses on the basis that it is not reasonably necessary, or that it is not related to your work injury. If the insurer declines to pay for your medical expenses they will need to provide written reasons in the form of a Section 74 Notice.

If the insurer declines treatment of medical expenses over the phone, make sure you ask them to provide a Section 74 Notice in writing outlining why they have declined your request. They must by law put the reasons for declining treatment in writing within 7 days.

It is important to obtain a Section 74 Notice as it is needed to challenge the decision of the insurer.

If the medical treatment dispute cannot be resolved and you consider the treatment to be reasonably necessary, you can make an application to the Workers Compensation Commission to appoint an independent Arbitrator to hear and determine the dispute.

You will need medical evidence to support the argument that the treatment is “reasonably necessary”, you lawyer will obtain this evidence on your behalf.

If you wish to challenge the decision of an insurer, you should contact an Accredited Specialist in Personal Injury Law like Garling & Co. We can help you with your medical expenses claim, simply get in touch with us through the below;

  1. Complete our FREE case assessment form HERE
  2. Email us at info@garlingandco.com.au
  3. Give us a call on (02) 8518 1120
More Faqs

Would you like assistance with your claim?

Complete our free, no obligation confidential case assessment form and we’ll get back to you within 24 hours.

Alternatively, we are available to talk through phone and email. Please contact our experienced workers compensation lawyers to find out how we can help.

No Win No Fee

You won’t be required to pay any fees until we win your case.

Industry Experts

We’re industry experts with over 20 years of experience.

Maximum Compensation

Our team of expert injury lawyers will help you get maximum compensation.

Jude M.
03:54 21 Feb 25
I rang Mr Matthew Garling on a matter, and Matthew gave me his time and honest advice from goodwill. Matthew is a very honest, good man of integrity who went beyond the call of duty. I would highly... recommend Matthew and his company.read more
Pouya Zadbar T.
01:36 15 Feb 25
Garling and Co were very helpful and did their best to get the most payout for my mothers workers compensation claim. We were very happy with their patience and understanding as this was a long and... trying process with the insurance. I Would definitely recommend their services.read more
Don T.
05:59 13 Feb 25
I had an occupational accident for 2 years and after the surgery for a whole year there was no good result and my body was in so much pain that I could not return to work. Everyone told me to find a... lawyer immediately, I did not know which lawyer could help me so I searched on Google. After searching I found that many clients were very satisfied with Garling & Co, so I texted Garling & Co. They immediately called back and asked if I felt pain and could not come to the office, they would come to see me but I replied that I could come. And the legal journey started from there. I met Mr. Garling who was about my age but very enthusiastic and dedicated and he explained and advised me in a way that I could understand all the questions and I agreed with him very much, then he handed over my case to Ms. Allison to contact me. Everything went very well according to his arrangements from the first step to the last step. Until the last day, he explained how the negotiation was going and I understood the whole story. I did not ask for too much and the number I gave was quickly agreed to avoid lengthy legal headaches. In total, after 4 years of the accident and almost 2 years with the help of Garling & Co, everything was resolved happily for all parties. Once again, I thank Mr. Garling, Ms. Allison and everyone at Garling & Co for helping me, they are wonderful and I hope they will continue their good work helping people who need legal help like I need help. Thank you very much Garling & Co.read more
Pedro M.
04:26 11 Feb 25
Thank you so much for all the help and support this past years.I recommend it to anyone who needs help.Thanks again and all the best for the Garling & Co team and a special thanks to Kerry Byrnes.
Ron J.
03:49 11 Feb 25
I had an overall good experience with Garling and Co. I was the victim of a major motorvehicle accident in April 2021. There were a few complications in my case including me having to move overseas... for 2 years temporarily during the progression of my claim and original lawyer from Garling that handled my case leaving the firm. The move overseas resulted in the insurer cutting off my income replacement, which lasted for 9 months, which as you can imagine created a major financial strain on the family On both these occasions, Garling worked to get a good result. They fought in front of the NSW Panel, and got a reported decision that states that all Permanent Residents and Citizens of Australia have the right to be paid income replacement even when overseas, during an accident claim under CTP cover. They also worked very hard in the face of a typically uncooperative and obstructive insurer to progress my claim over the last (almost 4 years) and the replacement lawyer Kerry Burns has done amazing work, with care, empathy and professionalism. I've had a good experience with them!read more
Sandra C.
03:27 06 Feb 25
Garling & Co Lawyers were professional from start to finish. They made me feel like I was as important to them as all their clients. Emma Perkins and her team went over and above in all aspects to... exceed my expectations. Highly recommended.read more
kokomo U.
01:38 15 Jan 25
Such a difficult time for me and so grateful to have alison and Mathews help...knowing I could trust in their knowledge, along with the understanding and compassion I received helped make a trying... time easier to navigate. Thankyou guys, would highly recommendread more
Sam H.
09:47 17 Dec 24
Very knowledgeable, explains everything very clearly and highly recommend.
Rachel R.
09:13 17 Nov 24
Although a long journey, the team at Garling & Co Lawyers have been amazing. They are thorough and clear with the processes and the expectations. It is a pleasure dealing with Emma and Rebecca. They... take all the weight off our shoulders when it comes to all the legal stuff and they make us feel comfortable and confident in their ability to look after us.read more
Angie & Brian M.
00:58 18 Sep 24
We cannot recommend Garling and Co. Lawyers highly enough! Our principal solicitor, Matthew Garling, was absolutely outstanding throughout our entire legal journey. He, along with the fantastic team... in the office, especially Allison, provided outstanding support. They were always responsive, willing to listen, and took the time to thoroughly explain the entire process. Thanks to their dedication and expertise, we achieved a brilliant outcome.read more
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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