Paying for Treatment After an Injury
If you have been injured in an accident, one of the first things you should do is speak to a registered Medical Practitioner about treatment that you may need to make the best recovery from your injury. If you were taken to the hospital after the accident, the Doctors at the hospital might recommend a treatment program. You can also talk to your regular General Practitioner.
There is a range of investigations and treatments that might be recommended by your doctor. These can include:
- X-rays and scans to fully diagnose your injuries;
- Physiotherapy;
- Cortisone injections;
- Working with an Exercise Physiologist for an exercise/strengthening programme;
- Counselling with a Clinical Psychologist;
- Assessment by a specialist surgeon;
All of these consultations and treatments need to be paid for. Medicare will pay some of the costs of seeing medical treatment providers, but not necessarily all of them. You will have to pay the difference between what the doctor charges and the Medicare rebate.
Physiotherapy treatment is not covered by Medicare. If you have private health insurance, your private health insurer might pay some of the physiotherapy treatment costs. However, there is usually a “gap” amount that you will have to pay as private health insurance does not usually cover the full cost of physiotherapy treatment.
Your GP might give you a GP Health Management Plan which allows you to claim a Medicare rebate for treatment such as physiotherapy and counselling. However, there is often a “gap” between the amount charged by the treatment provider and the Medicare rebate, and you will need to pay that “gap” amount.
What this means is that obtaining the treatment that you need following an injury can result in substantial out-of-pocket costs to you.
Is there any way to have these costs covered?
Yes, there may be a way.
If you are injured at work or in a car accident, the Worker’s Compensation Insurer and the Compulsory Third Party (“CTP”) insurer of the vehicle that caused the accident has an obligation to pay for “reasonable and appropriate” treatment for your injury. The Worker’s Compensation Insurer and the CTP insurer will cover the full cost of approved reasonable and appropriate treatment. They may also provide funding for assistance that you might need to return to work, for example, study courses, retraining and vocational rehabilitation.
Importantly, the Worker’s Compensation Insurer and CTP insurer can pay you to obtain treatment through the private health system. That means that you can see the treatment provider of your choice. If your injury requires surgery, the surgery can be performed in a private hospital so you do not have to go onto a waiting list for surgery at your local public hospital.
It is also important to make sure that you obtain approval from the Worker’s Compensation Insurer or the CTP insurer before you have the treatment and pay any costs. Insurers must pay for “reasonable and appropriate” treatment, so if you have treatment that they do not consider to be “reasonable and appropriate”, they may refuse to reimburse you for those costs. It is very important to obtain approval to pay those costs from the insurer before you have the treatment.
In some cases, there may be a disagreement between the insurer and the injured person about whether particular treatment costs are “reasonable and appropriate”. We have access to cases where the Court has been asked to resolve such disagreements and decide whether the treatment that has been recommended for the injured person is “reasonable and appropriate”.