Injury Management & Workers Compensation Solutions

Workplace accidents and injuries are unfortunately not always avoidable, however with Family Doctor, we aim to make them as painless for your business as possible. With integral relationships with your management team and staff, we aim to ensure your employees are retained in the workplace as much as possible throughout their recovery, greatly increasing their chances of a successful return to work. Our team will ensure your employees are provided with a proactive and responsive treatment plan, with careful involvement of your business at every step! 

Our Solution

Urgent Injury Care Avoiding Long Wait Times In the Hospital System

Coordinated Return to Work Planning Reducing Lost Time

Multidisciplinary Approach for Successful Return to Work

Direct Billing Agreements with Insurers with Claim Acceptance

Dedicated Practitioners Who Get to Know Your Business & Staff

Workers Compensation Guide

Workers Compensation is a form of insurance payment to employees if they are injured at work or become sick due to their work. Workers Compensation can include payments to cover

Employees wages whilst they’re not fit for work

Employees medical expenses and rehabilitation

  • Workers Compensation is governed by each state and territory individually, and each state and/or territory has a governing body to oversee the workers compensation system. Every employer must carry workers compensation insurance to cover their employees in the event of an accident, injury or work-related illness. It is also their responsibility to maintain a safe workplace for their employees. Sole Traders are not covered by standard workers compensation insurance and will need to make alternative arrangements to ensure they are protected. 
  • The workers compensation recovery process is overseen by a GP, what acts as the treatment coordinator, ensuring the patient receives the most appropriate treatment with the goal of returning them to work at full capacity in a timely manner. 

Workers Compensation Process Overview

  1. A worker is injured at work and reports the incident to their employer on an incident report form 
  2. The injured employee attends a general practitioner usually with their employer and a copy of the incident form, for initial treatment and the issuing of the initial certificate of capacity. At this stage any imaging or pathology required urgently is also arranged.  
  3. The Employee and Employer fill out the relevant claim forms to lodge a worker’s compensation claim to the insurer. The employer will also lodge the initial certificate of capacity provided by the GP.  
  4. The insurer will issue a letter of receipt for the claim information, this will include a case/claim number being assigned to the worker for the presenting injury. This is NOT an acceptance of liability, even though a claim number has been assigned. 
  5. The worker should continue treatment of the injury throughout this 28-day period. The accounts should be issued under the workcover fee schedule be paid by either the employee themselves or the employer if an agreement has been made, rebates through Medicare should not be claimed at this time.  
  6. The insurer has 28 days to investigate and respond to the claim in regards to liability. If accepted the worker and employer will be issued an acceptance of liability letter. A copy of this letter should be provided to the treating GP for their records.  
  7. Once the claim is accepted the treating GP and Employer will continue to work with the Injured Employee to return them to full capacity employment as soon as possible.  
  8. If the claim is rejected, any invoices paid by the employee may be reverted to Medicare for rebate.  

Corporate Agreements

Family Doctor will be looking into providing comprehensive care for Employers and their workforces. This will include agreeing to treat injured workers with priority as soon as possible after an injury is identified, this may include triaging injuries at the clinic as walk ins to avoid Emergency Department presentations.

The agreements will also address the liability for on the day payment of the consultations prior to the claim acceptance by the insurer. Once liability is accepted, the clinic will direct bill the insurance company for any services.

Treatment Process Flow

Injury Occurs & Treatment Begins

  • Injured Worker and line manager present to a Clinic for initial assessment and treatment
  • Extensive history is documented and the line manager provides the GP with a current position description along with a thorough discussion of alternative duties available to avoid lost injury time
  • Referrals for imaging and pathology offered if required, early intervention by allied health recommended if appropriate
  • Billing WorkCover 36+Case Conference

Ongoing Treatment

  • Injured Worker continues to see GP weekly & Allied Health practitioners as required
  • Once recovery is underway, appointments can be dropped out to fortnightly consultations with phone calls to the employer in between to ensure the light duties limits are acceptable, company management still to attend every second appointment
  • Billing WorkCover23/36+Case Conference every second consultation, phone calls billed as required, Capacity certificates issued at EVERY appointment

Claim Finalisation

  • Once recovery is complete, the injured worker should have returned to full duties and hours. A one month review is set before final sign off. The employer should have a representative at the final sign off appointment to ensure that the company and worker are happy with treatment completion
  • Billing WorkCover36+Case Conference
  • Treatment Reports may be requested by the Insurance company at the conclusion of the case, or if recovery is stagnating. Keeping thorough notes throughout the treatment process will make the compiling of these reports much easier. Billing should always reflect the content in the reports as compilation time should be minimal with good notes available

Mental Health Claims VS Workplace Bullying

  • Many work-based mental health presentations are centred around Bullying.  
  • It is not the role of the treating practitioner to resolve or advise on the Bullying accusations as they are a separate issue with a resolution path to be followed. Whilst bullying may result in stress, the workers compensation system is there for those who have suffered psychological injury or development of a diagnosis directly due to their work. A high proportion of Mental Health claims are rejected as they are more appropriately directed down a Company based investigation and resolution process.  
  • Employees whose primary complaint is of a bullying nature should be advised to approach their employer and follow the companies Bullying and Harassment Policy.  
  • If the patient does require mental health treatment, consider using the Mental Health Care Plan to outline the treatment steps and goals. Return to work for mental health cases should be closely managed in conjunction with the Employer to ensure a successful return to work.  
  • If you feel there is a mental health diagnosis appropriate to the situation requiring treatment, a Certificate of Capacity should be issued and appropriately charged for.  

Rejected Claims

Where an insurer rejects liability for an injury, all costs associated with treatment revert back to Medicare Eligible accounts.  This will be handled by the Admin team and Practice Manager.    

Contact us today

Our unique value proposition is the combination the locations of our medical practices in Australia, our turnaround time on results and our relationship with organisations to develop customised solutions.