What WorkSafe will pay for

The WorkSafe Agent (the Agent) can pay the reasonable costs of chiropractic services when required as a result of a work-related injury or illness under Victorian workers' compensation legislation (the legislation).

The Agent will periodically review an injured worker's entitlement to chiropractic services to ensure that the treatment and services remain reasonable for the workrelated injury and/or illness and are payable under the legislation.

Background

WorkSafe Victoria has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for the delivery of services to injured workers.

The Clinical Framework is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment
  • Adoption of a biopsychosocial approach
  • Empowering the injured worker to manage their injury
  • Implementing goals focused on optimising function, participation and/or return to work/health
  • Base treatments on best available research evidence.

WorkSafe Victoria expects that all health professionals providing services to injured workers integrate the principles of the Clinical Framework into their daily practice.

Further information about the Clinical Framework can be found at www.worksafe.vic.gov.au. This policy must be read in conjunction with the following:

  • Equipment and related services policy 
  • Gym and swimming programs policy

 Guidelines 

 What can the Agent pay for in relation to chiropractic services? 

 The Agent can pay the reasonable costs of chiropractic services: 

  • required as a result of a work-related injury or illness 
  • registered by WorkSafe to provide chiropractic services 
  • registered with the Chiropractic Board of Australia 
  • that are clinically justified, safe and effective 
  • that have a clear rehabilitative purpose and are not for non-work-related injury rehabilitative purposes 
  • that are likely to achieve or maintain a measurable functional improvement 
  • that promote progress towards functional independence, participation and self management. 
  •  Please note that the Agent will not pay for more than one initial consultation by the same provider or clinic unless there are exceptional circumstances, for example following a hospital admission or surgery, or where a significant period of time has elapsed since the injured worker last received treatment. 

Restricted consultations 

Restricted consultations require prior written approval from the Agent. The Agent can pay the reasonable costs of extended consultations where an injured worker requires treatment beyond that of a standard consultation including: 

  • moderate to severe acquired brain injury 
  • crush injuries 
  • extensive burns 
  • spinal cord injuries 
  • multiple orthopaedic fractures 
  • limb amputations. 
  • The Restricted Consultation application form must be completed by a chiropractor to apply for approval to use the restricted chiropractic consultation item number. It is recommended that chiropractors do not bill the restricted item consultation item number until they have been advised by the Agent in writing that their application has been accepted. Chiropractors can be reimbursed by the Agent for the completion of the Restricted Consultation application form. 

Consultations in the community 

  • The Agent can pay the reasonable costs of a consultation undertaken in a community setting, such as at a hospital, at home or at an injured worker's workplace. 
  • The Agent expects the injured worker to seek treatment from a provider in their local area. Please refer to the WorkSafe Chiropractic Fee Schedule for more information.

Radiological services 

Radiological investigations undertaken by chiropractors can only be paid by the Agent when performed by an appropriately licensed practitioner. All radiological investigations are paid in accordance with the WorkSafe Chiropractic Fee Schedule. 

Subsequent (Continuing) Certificates of Capacity 

 A chiropractor may complete a subsequent certificate of capacity if the injured worker's capacity for work is impacted due to a work-related injury. 

 A subsequent/continuing Certificate of Capacity can be issued by a chiropractor for up to a maximum of 28 days, unless special reasons apply and express approval is obtained from the Agent. 

Please note that only a medical practitioner can complete an initial Certificate of Capacity. 

 For more information about Certificates of Capacity please see www.worksafe.vic.gov.au

Who can provide chiropractic services? 

 Chiropractic services can be provided by a chiropractor who is registered with the Chiropractic Board of Australia to practice in the chiropractic profession. 

What information does the Agent require to consider paying for chiropractic services? 

The Agent does not require any information from a chiropractor before commencement of initial treatment for an injured worker's work-related injury. 

After initial treatment has commenced, the chiropractor will be required to submit a Chiropractic Treatment Notification to the Agent by the fifth consultation. 

This form provides information regarding the goals, strategies and proposed outcomes of the treatment. This information assists the treater, employer and the Agent to manage the worker's return to work. 

For injured workers part of the Community Integration Program the request, approval and submission of outcome measures for services will form part of the independence planning process. 

When will the Agent respond to a request? 

  • Within 10 working days of receiving a request for chiropractic services, the Agent will advise whether: 
  • the request has been approved 
  • the request has been denied, or 
  • further information is required to make a decision. 

Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receipt of the additional information. 

To assist the Agent make a decision regarding a request for ongoing chiropractic services, a request may be reviewed by a WorkSafe Medical Advisor/Clinical Panel member. 

The Clinical Panel/Medical Advisor may contact the requesting chiropractor to seek further information and/or discuss the proposed treatment prior to making a recommendation to the Agent regarding the request. The Agent will respond to the request when they have received the recommendations. 

What are WorkSafe's invoicing requirements? 

Refer to the How to invoice WorkSafe guidelines. 

What fees are payable for chiropractic services? 

Please refer to the Chiropractic services fee schedule. 

In relation to chiropractic services, what won't the Agent pay for? 

  • The Agent will not pay for: 
  • treatment or services for a person other than the worker 
  • treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation 
  • more than one initial consultation by the same provider or clinic 
  • the provision of multiple or concurrent physical treatments (for example physiotherapy, chiropractic, osteopathy or acupuncture) with exceptions such as group exercise or group hydrotherapy. 
  • pharmacy items such as creams and gels supplied by health professionals 
  • treatment or services subcontracted to, or provided by a non-registered provider 
  • fees associated with cancellation or non-attendance 
  • treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent 
  • treatment or services provided by telephone or other non-face to face mediums 
  • consumable prosthetics, aides and appliances used in the course of the consultation – for further information please refer to the WorkSafe policy for Equipment and Related Services 
  • consultations provided more than once on the same day to the same worker 
  • treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1, or level 2 evidence that the treatment, services, prostheses or equipment is safe and effective – refer to the WorkSafe policy for Non-Established, New or Emerging Treatments and Services.

Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided.