Providing early notification before cessation of medical benefits helps to ensure that workers have sufficient time to prepare for cessation and make any necessary arrangements.
Principle
Workers whose medical benefits are due to cease will be provided with appropriate notice before the cessation of those benefits.
Application
This standard does not apply to exempt workers
Expectations
Benchmarks
S19.1
Insurers are to provide written notification to a worker and the nominated treating doctor before the cessation of medical benefits and must include:
the date on which compensation for reasonably necessary medical treatment and services is due to cease, and
in the case of the worker, who to contact for further information (including the IRO).
Notification provided at least 13 weeks before cessation of benefits
Most workers are entitled to either two or five years of reasonably necessary medical treatment and services after their claim was first made, or from the date the worker’s weekly payments stopped being payable.
Medical and related treatment may be necessary to:
maintain wellbeing, as opposed to rehabilitation and/or return to work, or
develop appropriate strategies and pathways for a worker’s recognised injury and/or degree of permanent impairment, to ensure any specific or specialised dependency need is supported.
Workers may still require access to medical and related treatment after they cease to be entitled to medical and related expenses under the workers compensation legislation.
In these circumstances, it is our expectation that insurers provide necessary support to help determine where a worker can access services through the public/private system, and help them transition either during or on conclusion of the entitlement period.
