What WorkSafe will pay for
The WorkSafe Agent (the Agent) can pay the reasonable costs of gym and/or swimming programs when required as the result of a work-related injury or illness under Victorian workers compensation legislation (the legislation) following:
- The provision of a written request from a registered medical practitioner, physiotherapist, chiropractor or osteopath
- Written approval from the Agent to the worker.
In this policy:
- A health professional is a registered medical practitioner, physiotherapist, chiropractor, osteopath or an accredited exercise physiologist.
- A gym program is an exercise program that is developed and monitored by a health professional for a worker to perform independently in a gym for the purpose of rehabilitation. Programs are for a fixed duration, generally three months.
- A swimming program is an exercise program that is developed and monitored by a health professional for a for a worker to perform independently in a pool for the purpose of rehabilitation. Programs are for a fixed duration, generally three months.
- An appropriate gym and/or pool facility:
- is a commercial gym and/or pool facility designed for public use or a gym and/or pool within the premises of a health professional
- is located in a practical location, within a reasonable distance of the worker's home or work
- is designed and equipped for various modalities of exercise, sports and physical training
- has suitable equipment to meet the needs of the worker as recommended by the health professional
- has suitably qualified staff to ensure worker safety
- is registered and approved by WorkSafe to provide remedial services.
What can the Agent pay for in relation to gym and/or swimming programs?
The Agent can pay the reasonable costs of an gym and/or swimming program when:
- required as a result of the work-related injury or illness
- reasonable, necessary or appropriate in the circumstances
- requested in writing by a medical practitioner, physiotherapist, chiropractor or osteopath
- approved by WorkSafe under the Legislation
- developed and monitored by a health professional who will evaluate the outcomes expected from the program
- clinically justified and the program will assist the worker to achieve their specified physical rehabilitation goals
- it will assist a worker in transition from health professional based treatment to a self managed program
- the program is provided in accordance with WorkSafe's guidelines.
The Agent can pay for an initial three month gym and/or swimming program. In exceptional circumstances only, the Agent may consider paying for a subsequent program or an extended program (longer than three months).
Once a worker's functional condition has stabilised, the program will become one of maintenance and the worker will be responsible for self-funding any ongoing or future program.
The Agent will consider paying for assistance for a worker to attend a gym and/or swimming program when required due to their work-related injury or illness in accordance with the Attendant Care Policy.
Where can gym and/or swimming programs be provided?
- Gym and/or swimming programs can be provided at a commercial gym and/or pool facility or gym/pool within the premises of an allied health care provider registered and approved by WorkSafe.
What information does the Agent require to consider paying for gym and/or swimming programs?
Initial gym and/or swimming program
To consider paying the reasonable costs of an initial three month gym and/or swimming program, the Agent requires a request from a medical practitioner, physiotherapist, chiropractor or osteopath which states that the worker requires a gym and/or swim program for the rehabilitation of their work-related injury or illness.
The Agent may contact the medical practitioner or other health professional monitoring the program for further information about the request.
Subsequent gym and/or swimming programs
The Agent can consider paying the reasonable costs of a subsequent gym and/or swimming program on receipt of a request from a medical practitioner, physiotherapist, chiropractor or osteopath. The Agent may contact them for further information about the request.
When will the Agent respond to a request?
Within 10 working days of receiving the request, 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 receiving the additional information.
What are the WorkSafe's invoice requirements?
Refer to the How to Invoice WorkSafe guidelines.
What fees are payable for gym and/or swimming programs?
The Agent can pay the reasonable fees for a gym and/or swimming program up to a maximum amount as specified in the WorkSafe Fee Schedule for Gym and Swimming Programs.
In relation to gym and/or swimming programs, what won't the Agent pay for?
The Agent will not pay for:
- programs or services for a person other than the worker
- programs or services requested by an exercise physiologist
- extra services offered by the facility, such as spa or sauna or yoga classes
- casual pilates/gym and swim sessions concurrently or in isolation, except where casual swim sessions are required as part of a supervised hydrotherapy program provided by a physiotherapist at a third party swimming centre
- personal trainers
- a gym and/or pool membership chosen by a worker because it offers extra services when there is a standard gym available – the worker is responsible for funding the difference in cost in such a case
- services where the costs are not considered reasonable
- a gym and/or swimming membership for the purposes of maintaining physical fitness once rehabilitation goals have been achieved
- gym attire, swimming costumes or addition equipment
- more than one gym and/or swimming program at the same time
- concurrent gym and pilates memberships for workers, other than in exceptional circumstances such as where there is clinical justification and the memberships are part of an overall coordinated rehabilitation plan which has been approved by the Agent
- treatment or services subcontracted to or provided by a non-registered provider
- fees associated with cancellation or non-attendance
- treatment or services provided outside Australia without prior written approval from the Agent
- the cost of telephone calls and telephone consultations between health professionals and workers, and between other providers, including hospitals
- treatment or services provided more than once on the same day to the same worker
Contact the referring Agent or email [email protected].