Medical and related services

If injury prevents the worker from doing their normal job for seven days or more, they must nominate a treating doctor.

The nominated treating doctor must be prepared to work with others in the worker’s support team (including the employer, insurer, treatment and workplace rehabilitation providers) to manage the worker’s injury and implement the injury management plan.

The worker must authorise their nominated treating doctor to provide relevant information to the insurer or employer for the purposes of an injury management plan for the worker. They can do this by signing the certificate of capacity.

The nominated treating doctor can help facilitate a worker’s treatment and recovery from a work-related injury/illness by:

• educating them on their injury and recovery options
• recommending treatment to help in their recovery
• acting as the primary contact for treatment and recovery information for employers, insurers and other parties involved in the management of the injury
• working with the insurer and employer to develop an injury management plan
• reviewing their condition and capacity for work regularly
• completing the certificate of capacity
• applying the principles of the Clinical framework for the delivery of health services.

The insurer will coordinate the injury management plan and discuss proposed goals with the nominated treating doctor. This allows everyone to align expectations and work towards a common goal.

Facilitating return to work

It is important for the nominated treating doctor to understand the workplace and duties in the context of the worker’s injury or disease. To assist the nominated treating doctor, the worker can provide the doctor with:

• the details of their normal days and hours of work
• a description of their normal job and the duties performed
• support offered by the workplace for recovery at work
• contact details for their supervisor or return to work co-ordinator.

Change of nominated treating doctor

It is the worker’s right and responsibility to nominate a treating doctor who is prepared to participate in the workers recovery through work/return to work.

Consistent medical care is essential to the worker’s recovery through work/return to work after an injury.

Changing nominated treating doctors can interrupt good medical care, however there may be a good reason for change, including:

• the doctor has moved or has ceased practicing in the worker’s local area and they are no longer able to see them
• there is evidence that the management the doctor is providing is not helping the worker’s recovery at returning to work.

If there is reason to change nominated treating doctors, the worker must inform the insurer and/or the employer. The injury management plan must provide for the procedure for changing the worker’s nominated treating doctor.

If there is evidence that the nominated treating doctor is not helping with a safe recovery through work/return to work, the insurer may:

• ask a doctor experienced in workplace rehabilitation (injury management consultant) to review the management of the worker’s injury, and discuss the best course of action with the doctor and employer, or
• ask the worker to nominate another treating doctor.

Fees and invoices

In most cases, the nominated treating doctor will forward an invoice directly to the insurer.

The provider is not permitted to directly bill the injured person for services related to the claim.

Fees for medical practitioners are set out in the Medical Practitioner Fees Order.

The Fees Order specifies how much can be charged and what payment codes nominated treating doctors are to use. Fees Orders set the maximum amount payable per service and reiterates that workers are not liable for these costs.

No fees are payable for cancellation or non-attendances. Pre-payment of fees for reports or services is not permitted.

Invoices should include:

• the worker's first and last name, and claim number
• payee name, address, telephone number and email address
• payee Australian Business Number (ABN)
• name of the relevant service provider who delivered the relevant service
• in the case of medical practitioner services, the provider’s:
  • Medicare provider number (unless not registered with Medicare).
  • Australian Health Practitioner Regulation Agency (AHPRA) number
• in the case of invoices for surgery:
  • a detailed operation report including a description of the initial injury and an outline of the mechanism of injury, time surgery commenced and finished, intra-operative findings and the procedures performed, including structures that were repaired (stating the anatomic location) and technique of repair.
• relevant SIRA payment classification code or Australian Medical Association (AMA) Fee List item number (where applicable). Refer to the relevant Fees Order and the Workers Compensation Insurer Data Reporting Requirements.
• service cost for each SIRA payment classification code or AMA Fee List item number and service duration (if applicable).
• the date of service
• the date of invoice (must be on the day of or after last date of service listed on the invoice)

To prevent delays in payment, these details need to be provided on all invoices.