The role of the public hospital medical practitioner

The doctor’s role is to complete the medical certificate and provide clinical assessment and opinion. You will often be the worker’s first contact after an injury or illness at work and they can choose which doctor they see. Your first concern will be treatment. Explain the injury to the worker and reassure them that it will be managed so they can return to work as soon as is safely possible. It is important for you 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. If the injury prevents the worker returning to work, rehabilitation must focus on maximising functional independence. Your role in the scheme is to provide quality, well-timed and relevant treatment in managing injured workers.

Medical treatment and workplace rehabilitation are based on a medical model and your certification and approval is required for all treatment and rehabilitation services. The worker will need you to complete a workers’ compensation medical certificate which they will then submit to the insurer with their application for compensation. A current medical certificate is required for the ongoing payment of benefits.

The workers’ compensation medical certificate is essentially a communication tool between insurers, employers and medical practitioners. The insurer uses the information supplied on the certificate to decide and manage the claim. We have provided a sample medical certificate and guidelines for completion with this information. Books of medical certificates are routinely sent to hospitals.

Q-COMP distributes the blank certificates to medical practitioners, which are then lodged with the insurer. You can choose how involved you wish to be in managing the worker. For example:

• for workers who present to the emergency department but are not admitted – you could issue a workers’ compensation medical certificate to cover them until they can see their own GP.
• if the worker is admitted as an inpatient – you could provide ongoing medical management while in hospital care.

If you think the worker would benefit from a referral to a specialist or an allied health/ rehabilitation provider, you should refer the worker as soon as possible. You can communicate this to the insurer via the medical certificate or other means (phone, letter or fax).

Fees

96% of claims are accepted by insurers in an average of 9 days . Once a claim is accepted the insurer will pay for medical services according to the Public Hospitalisation Table of Costs (PHTOC). This PHTOC only applies to the costs of the services provided to a worker who:

• is admitted to a public hospital (an inpatient)
• receives treatment at a public hospital emergency department.

The PHTOC is based on the Queensland Health Public Hospital Cost Benchmarks and outlines the procedures, conditions, fees and item codes for the delivery of public hospital services (medical and allied health) in Queensland public hospital facilities to workers’ compensation claimants.

Outpatient services are provided 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 higher fee due to the complexity of some workers’ compensation claims.

Useful contacts

• Insurers - if your question is about a specific claim/case you will need to speak to the insurer’s case manager.
• WorkCover Queensland - if possible, use the direct number for the WorkCover staff member managing the claim. If you don’t have their direct number you can call WorkCover on 1300 362 128 and give the name of your patient, their date of birth or the claim number (if you know it).
• Self-insured employers - contact the employer directly (current list of insurers).
• Q-COMP  - contact Q-COMP’s Health Service Unit on 1300 789 881 or view the schedules of fees.