Elective surgery fact sheet

What WorkSafe can pay for

WorkSafe can pay for the reasonable costs of elective surgery you need to recover from a work-related injury.

Your agent must provide written approval before the elective surgery can be performed. WorkSafe is liable only for the reasonable costs in accordance with Victorian workers compensation legislation and guidelines.

Sometimes, a provider will charge more than the reasonable costs WorkSafe can pay. This is often referred to as "a gap". If this happens, you may have to pay the difference. It is your decision.

It is your decision to have any approved surgery.

Every surgery can have positive and negative impacts.

WorkSafe makes elective surgery a high priority because it can be an important part of your recovery.

Elective surgeries

Surgeries may include:

• joint replacements - knee, hip, ankle, shoulder
• joint reconstructive surgeries - knee, ankle, shoulder
• fusion surgeries - spinal and peripheral joints
• internal organ surgery - hernias
• amputations - the removal of the whole or part of an arm, hand, leg or foot.

What happens if I need surgery?

If your doctor advises elective surgery could benefit you, the following steps must occur.

1. You and your doctor will develop a post-surgery recovery plan.
2. Your doctor will ask your WorkSafe agent to approve surgery. They will describe the potential benefits, your current diagnosis, previous and current treatments, and your recovery plan.
3. You might be asked to attend an independent medical examination so your agent can be sure the surgery is right for you.
4. Your agent will review your request against the medical benefits schedule and WorkSafe's policies and fee schedules. Not all surgery requests are approved. You can have any decision reviewed.
5. Most elective surgery requests will have an outcome within 28 days. Complex requests may require information from more than one source. This may add to the time it takes the agent to make a decision.
6. If your surgery is approved your doctor may ask you to pay a "gap" between what they charge and WorkSafe's fees. You can get a second surgical opinion to avoid any potential out of pocket expenses.
7. If you are happy with the decision your surgery proceeds and your recovery plan begins.