The role of the general medical practitioner

An injured worker may see the doctor of their choice. The doctor will often be their first contact. Treatment of the injury is the first concern. The injury should be explained to the worker and reassurance given that it will be managed so that they can return to work as soon as is safely possible. It is important to establish this return to work expectation from the outset.

In the majority of cases, the rehabilitation goal is for the worker to return to work. In situations where the injury prevents the worker returning to work, rehabilitation must focus on maximising functional independence.

Your role in the scheme is to promote the provision of quality, timely and relevant treatment in the management of injured workers.

Medical treatment and workplace rehabilitation are based on a medical model and a doctor’s certification and approval is required for all treatment and rehabilitation services.

The worker will need you to complete a workers’ compensation medical certificate to submit to the insurer along with an Application for compensation which they must complete. A current medical certificate is required for the ongoing payment of benefits.

The medical certificate is essentially a communication tool between insurers, employers and medical practitioners. The information supplied in the medical certificate is used in the determination and management of the claim.

The doctor’s role is to complete the medical certificate and provide clinical assessment and opinion. It is the insurer’s role to assess and determine whether the person is a worker and if the injury is one that attracts benefits in accordance with the Workers’ Compensation and Rehabilitation Act 2003.

A worker is someone who performs work under a contract of service. This generally excludes the self-employed, contractors and directors/partners. Work must have been a significant contributing factor to the injury.

Certificates must be lodged with the relevant insurer - WorkCover Queensland or a self-insured employer.

Many workplace injuries resolve quickly with eight days being the median workdays lost. For more serious injuries, early intervention is favoured. As the worker’s treating doctor you will be monitoring the worker’s progress and communicating with the worker, and as required their employer’s Rehabilitation and Return to Work Coordinator (RRTWC), the insurer’s case manager and appropriate allied health providers.

Should you believe a referral to a specialist or an allied health/work rehabilitation provider will benefit the worker, referral at the earliest time is advocated. This may be communicated to the insurer via the medical certificate or other means.

Fees

96% of claims are accepted by insurers in an average of nine days . Once a claim is accepted the insurer will pay for reasonable medical services according to the Medical Items Schedule of Fees. The item numbers and descriptors are the same as those in the Medicare Benefits Schedule (MBS) but generally attract a slightly higher fee due to the complexity of some workers’ compensation claims.

Payment for any required communication that would not be considered part of a normal consultation (facsimile, teleconference, reports etc) is made according to the Medical Table of Costs - Supplementary Schedule.

If your question is about a specific claim/case or payment for specific services you will need to speak to the insurer’s case manager.

If possible, use the direct number for the WorkCover Queensland staff member managing the claim. If you don’t have their direct number you can call 1300 362 128 and give the name of your patient, their date of birth or the claim number (if you know it). Visit the WorkCover Queensland’s website at www.workcoverqld.com.au.

Contact the employer directly.

For general queries about fees or copies of schedules contact Q-COMP’s Health Services Team on 1300 789 881.