Primary care and
education
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.
Completing the workers'
compensation medical certificate
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.
Referring workers to other
practitioners
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.