Primary care and
education
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.
Completion of a workers'
compensation medical certificate
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.
Ongoing care, monitoring and
certification
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.
Referral as
appropriate
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.
Insurers
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). Visit the
WorkCover Queensland's website at www.workcoverqld.com.au
Self-insured employers
Contact the employer directly.
For general queries about fees or copies of schedules contact
Q-COMP's Health Services Team on 1300 789 881.