The role of general practice and hospital support staff

An injured worker may see the doctor of their choice. You or the doctor will often be their first contact. If you identify the injury is work-related, reassure the person 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.

Advise the doctor that the injury is work-related and ensure a workers’ compensation medical certificate is available for them to complete. Books of workers’ compensation medical certificates are sent to medical practices and hospitals upon request and some medical practice software includes a template of the workers’ compensation medical certificate.

Please note that while Q-COMP distributes the certificates, once completed they must be sent to the workers’ compensation insurer.

Completion of a workers’ compensation medical certificate

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

To make a claim, the worker will need to send the insurer a workers’ compensation medical certificate completed by the doctor along with an Application for Compensation which the worker must complete. An Application for Compensation can be obtained from the insurer. If WorkCover Queensland is the person’s workers’ compensation insurer and your practice wishes to assist the worker lodge their claim, you can invoice WorkCover Queensland for an extra 'fax fee'.

The doctor’s role

The doctor’s role is to complete the medical certificate and provide clinical assessment and opinion.

The insurer’s role

The insurer’s role is 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.

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 Commonwealth Medical Benefits Schedule (CMBS) 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 (fax, teleconference, reports etc) is made according to the Medical Table of Costs - Supplementary Schedule (General Practitioner or Specialist Medical Practitioner).

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.

• WorkCover Queensland - 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) or visit WorkCover Queensland’s website.
• Self-insured employers - Contact the employer directly (current list of insurers)

 Q-COMP - contact Q-COMP’s Health Services Team on 1300 789 881.