Treatment and approvals
As a treating doctor, your role is to manage treatment and provide rehabilitation support to injured workers. This includes:
- emergency and clinical care of the injury or illness
- guiding the rehabilitation process
- assessing capacity for work and providing work capacity certificates
- advising the employer, insurer, or return to work service provider, about a return to work program
- referring the worker to allied health or other services, if needed.
Rehabilitation and return to work
Research shows that work is good for health and that early return to work conversations can improve rehabilitation outcomes. It's important to talk with your patient about:
- what's needed for them to stay at, or return to, work
- the importance of self-management and staying active
- what suitable duties are and how important they are in maintaining health and improving rehabilitation outcomes
- how their employer is required to provide suitable duties but, if they can’t, we can arrange a host employer to help get them on the road to recovery
- how the rehabilitation process can take time and is a step by step process
- how their capacity for work will be reviewed regularly
- any other concerns.
Improved rehabilitation and return to work outcomes are achieved through:
- regularly assessing capacity and focusing on what can be done, rather than what can’t
- practical, goal-orientated rehabilitation that focuses on staying at, or returning to, work
- regularly communicating with the rehabilitation and return to work team, including providing reports, feedback and updates.
Each injured worker has a tailored rehabilitation and return to work plan developed for them, based on the information you provide us. These plans inform the rehabilitation and return to work process. An important part of this is the identification of suitable duties.
Suitable duties are tasks that an injured worker can do as they get better. They're usually time limited and enable a gradual return to the pre-injury role. We have a range of task analysis guides and plans that can help you identify suitable duties.
Surgical procedures and hospitalisation
If surgery is required, a Request for surgery approval form (PDF, 0.11 MB) will need to be completed and the surgery approved prior to any procedure and/or hospitalisation.
By answering all questions on the request form and applying the multiple operation rule if applicable, you speed up the decision-making process.
Also, if you answer the 'work-related diagnosis', 'pre-existing conditions' and 'time frames for return to work' questions, you can charge item code 100808.
Fees are payable under our current Medical Items Table of Costs.
In the case of an emergency, prior approval for surgery and hospitalisation is not required. The injured worker should be admitted to hospital and treated immediately.
We will cover up to four days as an in-patient at a private or public hospital. If further hospital time is required, please contact the claims owner/manager to discuss and seek approval before extending the stay.
Guidelines
Guidelines are available to provide treatment and billing guidance. Please use the relevant item numbers/codes in these guidelines when completing the Request for surgery approval form (PDF, 0.11 MB). This will speed up the decision-making process.
- Upper limb (PDF, 0.62 MB)
- Lower limb (PDF, 0.79 MB)
- Spinal (PDF, 0.56 MB)
- Pain intervention (PDF, 0.46 MB)
- Mental injuries (PDF, 0.39 MB).
Multiple operation rule
If two or more MBS items from Category 3, Group T8 are being performed on a patient on the one occasion, the multiple operation rule will apply when determining the fees payable for these services.
Items in Subgroup 12 of Group T8 (ie. amputations) are not subject to this rule.
Find out more about the multiple operation rule and how it is applied.
Submit requests
You can submit requests by:
- using Provider Connect
- via the 'Send or request information' function
- fax to 1300 651 387.
We'll respond to your request within 1-2 business days.
Medical reports
To help make a decision on or manage a claim, WorkCover may request a medical report from you. We use these reports to learn more about the work-related injury and the worker's condition.
Read more about medical reports.
Allied health
To support the return to work goal, you're able to refer to an allied health provider.
Complete a referral to the provider for the treatment, rehabilitation or return to work services required.
Read about what we will and won’t pay for.
Further investigations
If you arrange further medical investigations, you need to send a copy of the results to us.
MRI scans
MRI scan referrals must be completed by a specialist, even in urgent cases.
A general medical practitioner is only able to complete MRI referrals when specific clinical indicators exist. Refer to the latest Medicare Benefits Schedule for information on these.
Medical Advisory Panel (MAP) and Independent Medical Examinations (IME's)
At times we may seek additional guidance from our Medical Advisory Panel (MAP) or an Independent Medical Examination (IME). This is done for a number of reasons, including:
- clarification on the available medical information
- seeking further advice about the recommended treatment or rehabilitation direction
- obtaining another professional opinion.
As the treating doctor, we will advise you if this happens and of any recommendations provided.