Your employer has 10 days to lodge your documents with their Worksafe Insurer.

Your employer cannot refuse to receive the claim form from you (penalties can be imposed by Worksafe).

Your employer cannot sack you for lodging a Worksafe form. If this does occur, then contact your union immediately for assistance.

Once the insurer has received the documents from your employer they will review them and make a decision. Sometimes when making a decision they may require further information. This may include:

• Independent Medical Examination – you must attend any appointments arranged by the insurer to attend a doctor.
• Circumstance Investigation – we suggest that you do not talk with a Worksafe investigator as you are not legally required to. If approached, ring your union or Union Assist first.
• Report from your treating health practitioner (doctor)
  If you are claiming for time off work and medical expenses, even if you have since returned to work, the insurer has 28 days from when they receive the documents to make a decision on your claim. They will send you a letter advising of their decision to either accept or reject the claim. If the claim is rejected, you should complete a Request for Conciliation and send this to Union Assist, along with a copy of the letter from the insurer.

If you are claiming for just medical expenses the insurer (from 05/04/2010) has 28 days to make a decision. They will send you a letter advising of their decision to either accept or reject the claim. If the claim is rejected, you should complete a Request for Conciliation and send this to Union Assist, along with a copy of the letter from the insurer.

If you have not heard anything from the insurer outside these time frames contact your union or Union Assist.

You should contact your union or union representative regarding any concerns about returning to work.

Important things to know about Medical Expenses

Here are some important things to know about medical expenses following changes to the WorkCover law

If you are seeking any of the following services, you will now require a medical practitioner’s referral and prior approval before the initial service:

• aids and appliances
• attendant care
• childcare
• community access
• elective surgery
• equipment
• external case management
• gym / swimming programs
• hearing devices
• home exercise equipment
• implantable pain therapy
• MRI scans (where requested by a GP)
• Network occupational therapy
• Network pain mgt program
• Network psychology
• Occupational rehabilitation
• Pain mgt programs
• Pharmacy medications (specific ones)
• Private hospital expenses
• Removalist costs
• Respite care

If you are unsure whether the insurer will pay for a particular type of treatment / service, you should contact your case manager to find out what you need to do to obtain approval.

The following services require prior approval before subsequent services will be paid:

• acupuncture – after 2nd medical practitioner referral
• dietician – after 2nd medical practitioner referral
• district nursing services – after initial 4 services
• exercise physiology – after 2nd medical practitioner referral
• grief and loss counseling – after 2nd medical practitioner referral
• household help – after initial 12 week program
• naturopathy – after 2nd medical practitioner referral
• occupational therapy – after 2nd medical practitioner referral
• remedial massage – after 2nd medical practitioner referral
• social work – after 2nd medical practitioner referral
• speech pathology – after 2nd medical practitioner referral

The following are considered “treating health practitioners” for the purpose of getting a report. They need to be registered as a provider with WorkSafe (Victorian WorkCover Authority):

• GP
• dentist
• optometrist
• physiotherapist
• chiropractor
• osteopath
• podiatrist
• psychologist