Workers Compensation - reimbursement for treatment and approved treatment types

[JayW]

Hi,

I'm new to the forum and I'm just after some advice on people's experience.

Firstly, moderators if this isn't the correct section of the forum to post I apologise and could it please relocated if in the incorrect spot.

I have been diagnosed as having anxiety/depression by my GP back in February 2016 but it has been going on since early 2014. The primary cause for the diagnosis has been a series of workplace incidents leading to a mental illness.

i have submitted a claim for workers compensation and I'd like to know which treatments and/or services can be reimbursed.

I am seeing a clinical psychologist which I'm sure will be reimbursed. However, due to my illness I have put on in excess of 20kg in the last 2-3 years, which has led to being diagnosed with sleep apnea and requiring a cpap machine and a susceptibility to physical illnesses such as infections and migraines.

I guess my real question is: Can I claim reimbursement for a nutritionist, personal training/gym to get my weight and physical health under control?

From the reading I have done there is a credible link between mental health and weight gain, and weight gain and deteriating mental and physical health. My view point is my workplace caused a mental health illness, that illness caused unwanted physical side effects. So I should be able to get assistance with the side effects?

Any help would be appreciated, either official or your own experience.

thank you.

[jess334]

Hi JayW,

Welcome to the forums.

I have had a little experience with work cover as a health worker. I think each person's approved treatments are worked out between yourself, your health professional, and your Work Cover case manager.

There probably won't be a clear black or white answer, so you will probably need to wait for a case manager to be assigned to you before you get an answer.

Kind thoughts, Jess

[JayW]

Thank you for the info Jess.

[Rabbit33]

Hi JayW

I've been through the Worker's Compensation process for a similar situation, which caused a psychological injury. Diagnosed with Depression and Anxiety.

As far as the claim goes, if it has been accepted, they should send you out a letter which contains a lot of information on it. Definitely have a read through this.

You can also go onto the Worksafe website.

The reimbursements that you may be able to get regarding medical, could be anything that your GP can determine and prove was a direct result of your injury. Even with him doing that, you should still make sure it has been approved by your case manager (The Insurer of your employer) who is overseeing your claim. Be sure to double check any medical costs for reimbursements prior to seeking this treatment as not everything is covered.

Also, a lot of reimbursement costs have capped amounts where workcover will only reimburse up to what they believe is the maximum 'standard and reasonable' cost for that treatment. For example, your GP appointments, in VIC, the maximum amount to be refunded is $61.73 . and with psychologist appointments they are capped at $167.33.

So firstly, make sure any treatment you seek or get has been referred by your treating doctor who is looking after your claim. Secondly, contact your case manager and double check with them that the treatment your doctor has stated you require is covered under the reimbursement scheme and thirdly, make sure you ask them what is the capped amount to ensure you're not out of pocket. Make sure you also keep supporting evidence of treatment and any referrals you get from your doctor, make copies for yourself. You should also be able to request reimbursement costs for travelling to and from your appointments. I think that they have 30days from when you lodge your reimbursements for them to be refunded. So if they are pricey, be sure to get them into the insurer straight away to prevent any delays.

Hope this info helps you out. Happy to answer more questions to the best of my ability if you have any.

Best of luck! 🙂

[Over1t]

I'm employed as a WorkCover case manager and have been doing this for over 5 years. I manage complex claims, which basically means long term injuries, complex psych claims, brain injuries, people who have no capacity to ever return to any employment.

I never have approved any costs related to weight loss for a primary psych injury, I have been asked to pay for these costs many times, but I reject them each time.

A few of these decisions have progressed to the tribunal and then to the supreme court... I would avoid this at any cost, the only ones who win out of this are the lawyers.

Take advantage of all the medical treatment you can get from your psychiatrist, psychologist etc while you have your entitlements.

The legislation varies from state to state, so the legislation/case law in your state may be different from where I am located.

Email/call your case manager and ask - that would be the best start.

[JayW]

Thank you for your response.

I must admit though, it's frustrating to here you've never approved weight loss expenses. It takes little effort to find many reports linking weight gain to mental health issues and mental health issues to overweight people. My own treating practioners have recommended weight loss as a treatment for my anxiety/depression, and have been referred to a nutritionist.

My view is if it's part of a treatment plan it should be approved by work cover.

I'm not having a shot at you personally but it sounds like a dodge to me.

For disclosure, I'm a public servant and have experience dealing with govt politics and their motives for implementing procedure and policy.

[Over1t]

I appreciate that you find my response frustrating, with a bit of luck the policies may be different in the jurisdiction where you live/work.

I wish you well on your journey to better health.

[Rabbit33]

Hi JayW,
I can understand your frustration. The entire procedure can be frustrating to say the least, but at the end of the day, they are there to assist assist you with medical costs, travel and sometimes with weekly compensation, depending on what your claim has been accepted for.
As OverIt said; "Email/call your case manager and ask - that would be the best start"
I totally agree with this. Your assigned case manager is going to be able to assist you best with these enquiries. If you feel at any time you are not happy with their response or that it has been unfair, you can always reach out to 'ACCS' https://www.conciliation.vic.gov.au/ and get further assistance or request a conciliation.
Never hurts to ask the question. 🙂

Best of luck. I wish you all the best on your journey for a safe and healthy recovery! 🙂

[geoff]

Hello JayW, what I would do is ask your doctor to write a letter to the person handling your W/S claim, and suggest that an Occupational Therapist needs to visit you.

All travelling costs are to be reimbursed for each visit, you will need to ring W/S for a travelling form that you note down every trip to the doctor, and all the other people you have visited for your claim.

Take care.

Geoff.