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The role of a medical provider

Medical practitioners are responsible for the overall management of a worker's treatment and play an important role in the recovery and return to work process. This includes:

  • providing emergency and clinical care of the injury/illness
  • determining the best method of rehabilitation
  • assessing capacity for work and providing workers' compensation medical certificates
  • advising the employer, where appropriate, to develop a return to work program
  • referring the worker to allied health or other services if needed.

All statutory claims involve working with the treating medical practitioner, the worker, rehabilitation coordinator or employer, allied health providers and all other stakeholders. Organising treatment remains the responsibility of the treating medical practitioner. We rely on the medical information you provide us to develop a tailored rehabilitation program to help the worker get back to work after an injury.

Medical providers and return to work

Getting back to work is an important step in recovering from a work-related injury and it can be a difficult and emotional journey for a worker. It's important for you to explain to the worker what is needed for them to return to work and to listen to any concerns they may have about rehabilitation.

Doctors who communicate with the worker, employer, WorkCover and other allied health providers make a positive difference to the rehabilitation process. To further improve the rehabilitation process:

  • provide proactive, realistic, goal-orientated rehabilitation that focuses on the worker returning to work
  • communicate regularly and openly with the worker, WorkCover and the employer representative
  • provide reports, feedback and updates on the worker’s progress and/or any amendments to their treatment plan
  • follow the table of costs
  • participate in case conferencing as requested.

You can also visit the worker’s workplace as part of their injury management plan, which is billable under the workers' compensation system.

What we pay

We pay for services outlined in the table of costs and only cover costs associated with the accepted work-related injury. If we do not accept a claim, the patient is responsible for any costs.

Information on what we pay and how to invoice us.

 Guidelines

  • If you arrange further medical investigations, forward a copy of the results to us.
  • MRI scans can only be referred by specialists, or by Medical Practitioners when certain clinical indicators exist. Outside of these indicators, a specialist needs to complete the MRI referral forms for any urgent referrals.
  • You need prior approval for private hospitalisation.
  • As the treating surgeon, you need to:
    • complete the request for surgery form (it's mandatory to answer all questions)
    • consult the surgical guidelines to determine the appropriate surgical item number/s that you are proposing for this surgery
    • submit relevant account 
  • Surgical procedures should be invoiced according to the Medicare Benefits Schedule (MBS).
  • Referrals are required for treatment with other allied health providers, including:
    • physiotherapists
    • chiropractors
    • occupational therapists
    • exercise physiologists.

We may arrange for additional medical guidance from our Medical Advisory Panel (MAP) or an independent medical examination. As the treating doctor, you will be advised if these opinions are being sought and of any recommendations.

Medical certificates

If a worker says their injury was caused by work, you need to complete a workers' compensation medical certificate. This is a legal document used by Queensland’s workers’ compensation insurers to help determine and manage a claim.

This medical certificate tells us:

  • if the patient has a work related injury
  • if they should be off work
  • what we can pay for (for example lost wages, doctors fees, hospital, or rehabilitation interventions)
  • how long we can pay the worker.

As medical provider, the best way to support a worker’s return to work is by focusing on what functions they can do, rather than what they can't. If we know what they can do, we can develop a suitable duties plan, if necessary find a host employer, and get the worker back to work and on the road to recovery.

Follow these principles to help the worker return to work as quickly and safely as possible:

  • Assess the worker’s condition and communicate to them the importance of staying active and, if possible, at work to restore function and decrease disability or long periods of time off work.
  • Research shows that when a person is off work for long periods of time, the less likely they are to return.
  • Provide relevant medical treatment, identify any risks that may hinder their recovery or return to work, and set realistic treatment goals that focus on what the worker can do, not what they can’t.
  • Encourage, where appropriate, the worker to self-manage.
  • Identify suitable duties and possible workplace adjustments.

Sample medical certificates and other information about completing medical certificates is available on the Workers' Compensation Regulator's website. Doctors should contact the Regulator on 1300 789 881 to inquire about the electronic version of the certificate or to request more workers’ compensation medical certificates.

Submit a medical certificate or medical report online.

Medical reports

To help make a decision on or manage a claim, we may request a medical report from you. We use these reports to learn more about the ‘injury’ and the worker's condition. Medical reports need to be clear, informative and received as quickly as possible.

We will ask questions about:

  • the worker's incapacity
  • any injury management to date
  • circumstances surrounding the 'event' causing the injury (the injured worker will give the examining doctor an account of how the injury occurred)
  • previous or similar injuries
  • when and how a worker can return to work
  • if relevant, any potential permanent impairment from the injury.

You'll receive a report request from us with specific questions. All requested reports are paid in line with the medical table of costs and are potentially subject to release in accordance with our privacy policy.

Report writing for a physical injury claim

Report writing for a psychiatric injury claim

Orthopaedic reporting template

Comprehensive Clinical Reports 

Frequently asked questions

  • Do I have to reveal all details of the consultation?
    • We appreciate the nature of the doctor/patient relationship. You may limit the information provided, but basic information that we need includes what the patient said about work related events, examination findings and diagnosis and proposed treatment and rehabilitation options.
  • Why would I contact WorkCover?
    • to find out if a claim is accepted
    • to see if we will pay for a treatment or rehabilitation not usually covered by Medicare
    • to provide a verbal response to a request for a written report
    • to discuss a specific issue relating to a claim or patient.
  • Can I charge WorkCover for contact?
    • Yes. Common item numbers are available here or visit the our website for a more detailed explanation.
  • What is a provider management plan?
    • The provider management plan is a form used by allied health providers to advise our customer advisor of a worker’s progress and ongoing rehabilitation  needs.
  • How do I register with WorkCover Queensland as a provider?
  • Can I be added to the provider directory?
    • We have an internal directory of provider details. We use this to make referrals for certain services. It allows us to locate providers, depending on the services they provide and the areas they cover.

      To have your name added to the directory, you will need to register with us as a provider, and request in writing that your details appear on the directory. This will enable us to add your details to the directory, but does not provide any guarantee of work.
  • How do we charge for an appointment that has health queries not connected with the work-related injury?
    • Once the WorkCover claim is accepted, you will need to charge us for the percentage of the appointment related to the work-related injury, and Medicare for the remainder of the consultation (for example 50/50).
  • Can a workers’ compensation claim be lodged from the medical practice?
    • Yes, claim forms can be obtained from our website. The completed and signed application must then be forwarded together with a Workers’ Compensation Medical Certificate to us.
  • What is the role of treating versus independent doctors?
    • The treating medical practitioner is central to the processes of treatment and rehabilitation of work-related injuries. Recognising the doctor-patient relationship, we do not expect comment on matters of legislation, administration, or fraud. Instead, we will often engage independent doctors, usually specialists to complete examination and reports to help with assessing or managing claims.
  • What is case conferencing?
    • Case conferencing is where the doctor agrees to the booking of a mutually satisfactory time to receive a clinical report and/or to discuss future treatment, rehabilitation or return-to-work needs. Case conferencing can be conducted face-to-face or over the telephone and is paid for in 15-minute blocks, and can be initiated either by a health provider or by us.
  • How are claims closed?
    • Claims can be closed in two ways:
      1. Legal closure—based on a legislative requirement:
      • when a damages action is settled (s119)
      • when weekly payments of compensation stop (s144(a))
      • when payment of medical treatment, hospitalisation and expenses stop (s144(b))
      • no further compensation for an injury after receiving a lump sum offer (s190(2))
      • when there is a conviction of fraud (s537).
      2. Administrative closure—based on an administrative decision:
      • redemptions
      • on review it becomes apparent that the person was not a ‘worker’ or there was not an ‘event’
      • when a work-related incapacity stops.
  • What happens when a claim is closed?
    • Once a claim is closed, the worker is not entitled to any further compensation benefits and we will not pay for any further treatment after this date.  
Last updated
24 March 2014

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