4.2 Information available
4.2.1 Information for workers | 4.2.2 Information for employers | 4.2.3 Information for service providers | 4.2.4 Provider payment for services | 4.2.5 Provision of mobile app PERX
Information is available to help workers, employers and service providers.
4.2.1 Information for workers
This section should be read in conjunction with - A guide for injured workers.
Return to work
WorkSafe can pay the reasonable costs of medical and like services directly related to a worker’s injury or illness. The primary goal when paying the reasonable costs of medical and like services is that the service provided is reasonable and necessary and aids or assists the worker to achieve a safe, sustainable return to work.
When entitlement to medical and like services ceases
For information on when a workers entitlement to medical and like services ceases.
See: Terminate medical & like services
WorkSafe payment to provider
WorkSafe provides guidelines and fee schedules to help determine the reasonable cost of a service.
The legislation specifies that a provider cannot take legal action against the worker for recovery of costs for which WorkSafe or the employer is liable to pay.
Payment of the reasonable costs of medical and like services does not necessarily mean payment of the full costs. In some cases there may be a gap between what the provider charges and what WorkSafe can pay.
If a provider chooses to charge more than the amount determined by WorkSafe, the Agent will normally not accept liability for the additional amount even where there are no other providers who will charge the recommended fee.
A provider may make an arrangement with a worker to charge an additional amount (gap) at the workers' expense. However, the worker is under no obligation to accept such an arrangement and may wish to seek services from another provider who does not charge more than the reasonable costs specified by WorkSafe.
Choice of provider
A worker has the right to use WorkSafe registered provider of their choice. However, WorkSafe is only liable to pay the reasonable costs of the service if it is by a registered provider and the service meets the requirements of the legislation.
There is a provider search function located on the WorkSafe website that may assist a worker in finding a registered provider.
There is also a WorkSafe mobile app that can assist in finding a provider.
See: A-Z of medical & like services for information about provider registration requirements for specific services.
Time limit for claiming medical and like expenses
The legislation provides that claims for compensation for all medical and like services must be made within six months of the service date.
How to get an account paid
Workers may not be required to pay accounts at the time of the service. The provider should forward accounts to the employer unless arrangements have been made to forward the account directly to the Agent.
WorkSafe provides fee schedules to service providers to advise them of what WorkSafe has determined as the reasonable costs for particular services.
If a worker chooses to pay an account at the time of the service, they should check whether the provider intends to charge more than WorkSafe determined ‘reasonable costs’ of the service to avoid being out of pocket.
If a worker has paid an account and is seeking reimbursement, WorkSafe is only liable to reimburse the reasonable costs for the service.
WorkSafe’s fee schedule can be found on the WorkSafe website.
Role of Agent
The Agent carries out the day-to-day administration of claims and payments. An employer can select from a panel of Agents to administer their WorkCover Insurance.
If a worker is injured and receiving weekly payments, the Agent should:
- help with any questions about entitlements or the claims process
- inform the worker of any changes to entitlements and why these changes have been made
- assist with management of the injury by approving reasonable, necessary and appropriate treatment in consultation with THP Treating Health Practitioner
- consult with healthcare professional to assess what duties the worker can do while recovering to help with RTW Return to Work and recovery
- advise the worker and employer about their obligations and responsibilities
- arrange occupational rehabilitation services where appropriate in accordance with the legislation
- arrange examinations or request information from THPs to review entitlements and capacity for work.
Vic Claim app
If you have been injured at work, you can find the information you need through the Vic Claim mobile app.
This includes useful material to help understand the claims process, entitlements and other information relating to your claim. The app is simple, easy to use and will guide you through the Victorian workers’ compensation process. If you have an accepted claim, you can use the app to easily email claims documents to your Agent and find registered providers for certain services.
The Vic Claim app can help a worker with:
- knowing what to do after a work related injury
- the process of making a claim and what happens after the claim is forwarded to the agent, including what support worker’s may be able to access whilst a decision regarding the claim is being made
- determining what information is needed after a claim decision has been made
- determining which treatments are available to assist recovery and those the Agent needs to be approve
- finding registered providers in the worker’s local area
- emailing documents to the Agent
- understanding your entitlements and benefits.
4.2.2 Information for employers
This section should be read in conjunction with - A guide for employers.
Liability
If an Agent accepts liability to pay compensation for a claim, the employer (unless they have chosen a buy-out option) must pay an excess being:
the first 10 days of weekly payments and
up to an annually indexed amount of reasonable medical and like services costs, unless the worker is entitled to provisional payments on a claimed mental injury. Accounts for medical and like services costs above the excess, or where the worker is entitled to provisional payments should be forwarded to the Agent.
If a worker receives services from an employer who has made adequate arrangements to provide workers with gratuitous services, the employer is deemed to have discharged their liability to pay the excess to the value of the services. Any amount that exceeds the excess may be claimed from WorkSafe.
If the worker’s claim is rejected by the Agent, the employer is not liable to pay the reasonable medical and like services costs incurred. However, the worker may appeal the decision to reject the claim and the employer will be liable to pay the excess if the claim is later accepted or determined in the worker’s favour.
Role of Agent
If an employer is unsure about whether services the worker has requested or received should be paid as part of the WorkSafe claim or the costs of the service are reasonable, they should seek advice from the Agent.
4.2.3 Information for service providers
The legislation specifies that some providers must be registered under the Health Practitioner Regulation National Law. Other providers must be approved by WorkSafe. WorkSafe requires all providers to be registered with WorkSafe to provide services to workers. A worker is entitled to choose their own healthcare professional who is registered with WorkSafe. There are no lists of preferred healthcare professionals, nor can WorkSafe or Agents provide referrals to practitioners.
How to register to provide services to workers
To register to provide services to a worker a provider needs to:
- meet the criteria for registration for the service type seeking to be provided, as detailed on the registration form and relevant provider information sheet and
- complete a Service Provider Registration Application relevant to their service type.
Mandatory registration requirements
WorkSafe has mandatory registration requirements for different healthcare professionals. Some are required to have professional indemnity insurance and be eligible for membership with the relevant body specified for their discipline.
For new registrations, service providers need to complete the Application for Registration to Provide Services to Workers form and sign section six (declaration and consent) only.
Applicants who meet WorkSafe registration requirements will be issued with a WorkSafe provider number.
A locum tenens requires a WorkSafe provider number to bill for services if the locum tenens is to provide services at a practice location for more than two weeks or will be providing services at the location for less than two weeks but on a regular basis.
Where to get an application form
Application forms are available:
- on WorkSafe website at www.worksafe.vic.gov.au or
- by telephoning the WorkSafe Advisory Service on freecall 1800 136 089 or 03 9641 1444.
If a practice moves and/or changes address or phone number the provider should notify WorkSafe in writing, including the effective date of change. This advice can be:
- faxed to: 03 9641 1767 or
- posted to:
Provider Registrations
WorkSafe Victoria
PO Box 279
GEELONG VIC 3220 - emailed to: service_provider_registration@worksafe.vic.gov.au.
A WorkSafe provider number is specific to a single practice address. For prompt and accurate payment of accounts a provider must:
- notify WorkSafe in writing of any additional practice location and phone number, including the date commenced practising at the address so that additional provider numbers may be issued
- sign and include their provider number on all notifications. Notifications can be:
- faxed to: 03 9641 1767 or
- posted to:
Provider Registrations
WorkSafe Victoria
PO Box 279
GEELONG VIC 3220 - emailed to: service_provider_registration@worksafe.vic.gov.au.
Provider number
WorkSafe provider numbers are allocated according to individual qualifications.
Note: The use of provider numbers by other people places the provider in breach of their agreement with WorkSafe and may have legal consequences.
WorkSafe has adopted the Medicare Australia provider numbers and registration details for medical practitioners. The medical practitioner's Medicare numbers will be used by WorkSafe for invoicing purposes.
Referral/request requirements
A medical practitioner request is required from a practitioner for all healthcare services except chiropractic, dental, osteopathy, optometry, physiotherapy and podiatry.
A medical practitioner is the only healthcare professional who is able to provide a request to another health service.
Information for service providers - COVID-19
Service providers should follow the advice of the Federal Department of Health and the Victorian Department of Health and Human Services in relation to the prevention of the possible spread of COVID-19.
4.2.4 Provider payment for services
WorkSafe can pay for the reasonable cost of a medical and like expense where there is an entitlement under the legislation, including:
- on an accepted claim, or
- where a worker is entitled to provisional payments on a claimed mental injury.
Provisional payments for a claimed mental injury can be made either until either the claim is accepted, after which the worker becomes entitled under the accepted claim, or if the claim is rejected, for 13 weeks after the day the worker is determined under section 75A to be entitled to provisional payments.
See: 6.5 Provisional payments for a mental injury
If the worker can provide their claim number, providers should contact the Agent or self-insurer to determine whether the worker’s claim has been accepted, or whether they are entitled to provisional payments. If the worker does not have a claim number or the provider is unsure who the Agent is, they can contact the WorkSafe Advisory Service on free call 1800 136 089 or on 03 9641 1444. The advisory service can provide advice about:
- whether a claim has been made and/or whether liability has been accepted by WorkSafe on the claim, or for any provisional payments the worker may be entitled to
- the Agent’s name and address.
Before phoning the advisory service, the provider should ensure they have the following details:
- worker’s name
- worker’s address
- worker’s date of birth
- worker’s date of injury and nature of injury
- employer’s name.
Note: Agents have:
- 2 business days from receiving early notification from an employer about a mental injury claim to make a determination about provisional payments
- 28 calendar days from the date of lodgement of a claim for compensation to accept or reject liability on the claim.
In the event that liability for the claim has been rejected, payment of the account normally rests with the worker, unless the employer has agreed to pay it or unless the worker is entitled to provisional payments on their claimed mental injury, in which case reasonable costs of the mental injury treatment are payable by WorkSafe for 13 weeks.
Employer threshold
When liability has been accepted on a claim, the employer is required to pay the initial medical and like expenses (except family counselling, burial or cremation, supported accommodation services and car and home modifications) up to a threshold amount (unless the below exceptions apply). Payment of these initial expenses must be made by the employer before any payments can be made by the Agent or self-insurer.
Before the threshold is reached - invoices should be sent to the employer.
Once the threshold is reached - invoices should be sent directly to the Agent.
No medical excess is payable by an employer in relation to a claim where:
- the employer has taken the buy-out option.
- the employer has already paid the excess directly to the Agent.
- the worker is entitled to provisional payments for a claimed mental injury – in this case no medical excess is payable by the employer for the life of the claim even if the claim is for both a physical and mental injury.
If any of the above circumstances apply, or if the employer has already reached their medical excess threshold, invoices should be sent directly to the Agent for payment.
Information required on the invoice
Invoices that are incorrect or incomplete will be returned by the Agent for completion.
To facilitate prompt payment of accounts, invoices must include:
- invoice number and/or date of invoice
- worker’s name, claim number and date of injury (where claim number is unknown please include the worker’s date of birth)
- employer’s name
- provider’s details including Name, ABN Australian Business Number and WorkSafe provider number
- service provided, date provided and item number.
Please refer to WorkSafe's website on how to invoice for more information.
Direct entry payments
Payments will be made by cheque unless a Direct Entry Application is completed. This application form is available:
- on the WorkSafe website
- by telephoning the WorkSafe Advisory Service on free call 1800 136 089 or 03 9641 1444.
Once registered, direct entry payments can only be varied in writing, whether for a cancellation of direct entry payments or a change of bank accounts.
Provider has difficulties obtaining payment
From an employer
If a provider experiences any difficulties in receiving payment which cannot be resolved directly with the employer, they should call the Agent or self Insurer providing a copy of the invoice and supporting documentation.
If a provider does not know the Agent or Self Insurer they can call the WorkSafe Advisory Service on free call 1800 136 089 or 03 9641 1444 to get the name of the employer’s Agent or self-insurer.
The Agent or self-insurer will liaise with the employer to arrange payment of the account/s.
From an Agent
It is expected that accepted medical and like services are paid by the Agent within 30 days of receipt of the invoice. Delayed payment of accounts may be caused by but not limited to:
- incorrect information on the invoice
- account not itemised correctly
- treatment not related to the compensable injury claim or to any provisional payments the worker may be entitled to
- no evidence of prior approval for the provided service or item
- no request received from the treating medical practitioner
- concern about the appropriateness of treatment or the costs of treatment. Accounts may be withheld while the concerns are investigated.
From a self-insurer
Self-insurers are under the same obligations as Agents to pay the reasonable costs of medical and like services. It is expected that accepted medical and like services are paid within 30 days of receipt of the invoice. Payment should be followed up with the self-insurer.
Note: If the issue is not resolved or there are ongoing difficulties with a particular employer, self-insurer or Agent full details can be forwarded together with all supporting documentation to:
Complaints Resolution Team
WorkSafe Victoria
PO Box 279
GEELONG VIC 3220
4.2.5 Provision of mobile app PERX
Worksafe can pay the cost of the mobile Perx app for the first 6 months of an accepted standard time lost claim. Following the claim acceptance, a worker will be contacted directly by Perx and offered the mobile app via a combination of email and SMS. For those workers who take up the offer of the Perx app, the app will be available for a maximum of 6 months. Agents will be billed directly as a claims management cost to be paid via payment type 130, item number “PERX”. If funding is requested past 6 months this will not be considered and the worker is encouraged to explore self-funding.