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Will my medical expenses be covered by WorkCover WA?

Tindall Gask Bentley senior associate Nakkie Le Roux explains how medical expenses are paid under the Workers’ Compensation and Injury Management Act 1981 (the Act).


“How will I pay for all of this?” It’s a question we are often asked by injured workers who fear for their long-term health and are unsure how they will cover their medical expenses. Thankfully, there are some protections in place for injured workers.

If you have lodged a workers’ compensation claim with your employer and the claim has been accepted by your employer’s insurer you are then entitled to be compensated for reasonable medical expenses for treatment (medical expenses).  Medical expenses are currently limited to a prescribed amount of $67,476.00 and increased annually on 1 July. In certain circumstances further amounts may be payable and usually requires you to make an application to WorkCover WA. Your social and financial circumstances, among other issues such as medical opinion, will be considered when assessing your eligibility for an extension of medical entitlements.

Pursuant to Schedule 1 Clause 17 of the Act, compensation is payable in respect of medical expenses such as first aid and ambulance services, medicines, medical or surgical treatment, dental treatment, physiotherapy, chiropractic and hospital treatment. You may also be compensated for the repair or replacement of items such as hearing aids, artificial limbs, artificial teeth and spectacles damaged or destroyed during the course of your employment.

In some circumstances a dispute may arise between yourself and the insurer as to what is reasonable treatment and may require you to make an application at WorkCover WA. In such circumstances it is recommended you seek independent legal advice.

You remain entitled to compensation of medical expenses under the Act even if weekly payments have stopped. You are entitled to secure the services of a doctor or health practitioner of your choice. It is your responsibility to ensure that all invoices are sent to the insurer for payment. It is important to note that the insurer will only reimburse for medical expenses at certain specific rates. This means that not all your expenses will be covered. If there is a “gap” you will be responsible to pay the gap to the service provider.

What happens to workers who might need medical treatment and surgery in the future?

In some instances the insurer might offer a lump sum payment to finalise your claim and conclude future entitlements, including future medical expenses. This is known as a redemption. Redemption is a full and final settlement of your claim which extinguishes your rights to make future claims. It is recommended you seek independent legal advice to assist you in advising and negotiating a redemption.

Everyone’s circumstances are different. As such, it is important you speak to a lawyer so that you understand your rights and are able to make informed decisions. Tindall Gask Bentley Lawyers are workers’ compensation specialists. Book a free initial interview with our West Perth team today on (08) 8211 9500 or register your details here and we’ll be in touch soon.

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