Hearing services and devices guidelines

The provision of hearing services and devices

These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985.

WorkSafe will have regard to these guidelines when making decisions for the provision of hearing services and devices to people who have an accepted claim under the Victorian Workers Compensation Scheme.

Throughout these guidelines, any reference to WorkSafe also includes WorkSafe’s agents and self-insurers.

Hearing services and devices

WorkSafe can fund hearing services and devices to assist people to effectively recover from workplace injuries and safely return to work and life.

Hearing services include the following.

• Hearing needs assessments by an audiologist or audiometrist.
• Submission of a ‘Hearing assessment and device request form’, or a ‘Hearing assessment and device exception request form’.
• Provision and review of hearing devices.
• Fitting, repair, adjustment or replacement of hearing devices and supply of hearing device batteries.

What we can pay for

WorkSafe can pay the reasonable costs of hearing services and devices a person needs as a result of a work-related injury or illness under Victorian workers compensation legislation.

The service must meet the following criteria.

• Be clinically justified, safe and effective.
• Be likely to achieve measurable improvement in a person’s functioning.
• Promote progress toward a person’s functional independence, participation and self-management.
• Be for rehabilitation purposes for a work-related injury only.
• Be delivered in line with WorkSafe’s Clinical framework.

WorkSafe will periodically review a person’s entitlement to hearing services and devices to make sure they remain reasonable, clinically justified, outcome focused and payable under the legislation.

WorkSafe can pay the reasonable cost of services outlined in the ‘Types of hearing services’ section in these guidelines.

Services and devices we will not pay for

Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following hearing services and devices.

• Services that are not required as a result of a worker’s accepted injury or illness.
• Services for a person other than the person with an accepted claim.
• Services that are not a reasonable cost as determined in accordance with the Victorian workers compensation legislation.
• Services provided outside of Australia without prior approval from WorkSafe.
• Services provided by a person who, either:
  • is not a ‘Member Accredited’ member of Audiology Australia
  • is not a full member of the Australian College of Audiology incorporating the Hearing Aid Audiology Society of Australia (ACAud inc. HAASA)
  • is registered as a student.
• Services delivered by providers who are not approved and registered with WorkSafe to provide these services.
• Services and/or devices that were provided without prior approval from WorkSafe.

Under WorkSafe’s determination of reasonable cost, WorkSafe will not pay for costs relating to the following.

• Services not in the hearing services fee schedules, unless a request for an exception device has been approved.
• Services provided more than once on the same day to the same worker.
• A single service billed to more than one claim held by the worker.
• Fees associated with cancellation or non-attendance or services not provided to the worker.
• Services where the service provided cannot be substantiated by contemporaneous clinical records and/or attendance records.
• Services provided by phone or other non-face to face mediums that do not align with WorkSafe’s telehealth policy.
• Unsolicited treatment or consultation with a worker.

Other services WorkSafe cannot pay for are outlined in the ‘Types of hearing services’ section of these guidelines.

Accessing services

Hearing services do not require prior approval unless being provided to a worker with an accepted hearing loss and/or tinnitus claim.

Types of hearing services

Hearing needs assessment

WorkSafe can pay the reasonable costs of a hearing needs assessment to determine the worker’s hearing needs and/or tinnitus resulting from their work-related injury. This is expected to take place once every 5 years and includes the following.

• Undertaking a range of diagnostic testing.
• Setting agreed rehabilitative goals with the worker.
• Recommendation of options for achieving any goals at a reasonable cost.
• The provision of clinical justification for any proposed options.
• Completion of the ’Hearing assessment and device request form’ or the ’Hearing assessment and device exception request form’.

If an alternative and/or replacement device is required, see the ‘Replacement devices’ section of these guidelines.

Hearing device fitting package

WorkSafe can pay the reasonable cost of a hearing device fitting package once every 5 years. This includes the following.

• The provision and fitting of the hearing device(s) and any assisted listening accessory (ALA) fitted at the same time or within 12 months of the fitting of the hearing device(s).
• Any consumables required for the first 12 months, including batteries.
• All subsequent follow-up consultations required to facilitate the worker's understanding of, recovery from, or adjustment to their work-related hearing loss and/or tinnitus for 12 months from the date the device was fitted.
• Any handling costs involved in supplying the hearing device(s) and/or ALAs.

The hearing device fitting package does not include the price of any hearing device or ALA. See the 'Hearing device' section in these guidelines.

WorkSafe may consider approval of an additional hearing device fitting package within a 5-year period if the following applies.

• A worker was initially supplied with a monaural hearing device.
• There is significant clinical evidence the worker now requires a binaural hearing device.

In these circumstances, the fitting of the binaural hearing devices can be paid only after written approval from the agent. It will be paid as the difference between the monaural and binaural fitting package fees.

A hearing device fitting package is not payable where the worker is provided with an ALA only.

See the ‘Assistive listening accessory’ section in these guidelines.

Hearing devices

WorkSafe approved hearing device list

The WorkSafe approved hearing device list contains a range of hearing devices with features identified by WorkSafe that will meet the majority of workers’ needs.

Hearing service providers must refer to the current list to make sure the device they are prescribing is approved. Where a device from the list is requested but is subsequently removed before billing, WorkSafe will consider the device to be an approved device.

Pricing for the devices is commercial in confidence. It can be obtained by contacting the applicable manufactures and requesting their specific WorkSafe list. This list will contain the agreed pricing information and WorkSafe item codes.

The list is reviewed annually and any enquiries regarding adding hearing devices and ALAs to the list can be emailed to the relevant agent.

Non-list hearing devices

WorkSafe can pay the reasonable costs of a hearing device where the provider can demonstrate the following.

• The non-listed hearing device is clinically required to meet the worker’s functional and communication needs.
• There is no hearing device on the current approved list that meets those needs.

In making the decision, WorkSafe will consider the following.

• Information provided on the ‘Hearing assessment and device exception request form’.
• Supporting clinical justification for the additional features in the context of the worker's communication and/or functional needs.
• Medical or clinical requirements that indicate or contraindicate the use of particular features of the proposed hearing device.

Assistive listening accessory

WorkSafe can pay the reasonable costs of ALAs to overcome an individual’s hearing loss and/or tinnitus by way of transmitting, processing or amplifying sound. An ALA is not a hearing device and does not consider the person’s individual hearing loss and/or tinnitus profile or audiogram.

ALAs can be used with or without a hearing device. Where an ALA is provided to a worker who has been, or will be, fitted with a hearing device, the hearing service provider must provide clinical justification to support the need for the ALA in addition to the hearing device. If the worker is being fitted with a new hearing device, the agent may request the new hearing device is evaluated for a period of time before considering a request for an ALA.

Where an ALA is provided within 12 months of a hearing device being fitted, no further fitting fee is payable. See the description of services included in the ‘Hearing device fitting package’ section.

Where a worker is provided with an ALA only or where an ALA is requested and approved more than 12 months after the fitting of a hearing device, the agent can pay for a hearing consultation associated with the provision of the ALA.

WorkSafe can pay the reasonable cost of a hearing consultation, review, device maintenance and/or ALA fitting 12 months after the fitting of a hearing device. These costs are limited to a maximum of 7 hours of service within 5 years of the fitting of a hearing device.

Any hearing rehabilitation, ALA fitting and adjustment of hearing device(s) within 12 months of the fitting of a hearing device is covered by the hearing device fitting package. WorkSafe will not pay a hearing consultation, review and/or maintenance fee.

After this period, WorkSafe can pay for hearing device maintenance, adjustment ALA fitting and aural rehabilitation if it is necessary. This is to make sure:

• the device is functioning to specification
• the worker understands, is recovering from, or has adjusted to, their work-related hearing loss and/or tinnitus.

Where a worker is recommended for an ALA following their hearing needs assessment, WorkSafe can pay for a hearing consultation, review and/or maintenance fee to cover a consultation only for the purpose of providing the worker with the ALA and educating them about the use of the ALA.

Hearing device battery supply

WorkSafe can pay the reasonable costs of battery supply for a hearing device 12 months after the fitting of a hearing device. The initial battery supply is included in the hearing device fitting package and provided to the worker at the time the hearing device is fitted.

A hearing device battery supply includes:

• a 12-month supply of batteries for a single hearing device
• any service component required to supply the batteries to the worker.

A hearing device battery supply should be provided only when requested by the worker.

Hearing device repairs

WorkSafe can pay the reasonable costs of maintenance repairs to hearing devices caused by normal wear and tear. WorkSafe will not pay for any repairs or maintenance to devices that are covered by manufacturer or supplier warranty.

All approvals for the reasonable costs of hearing device repairs will be considered only on receipt of a copy of the manufacturer's invoice for the repairs.

Replacement hearing devices

WorkSafe can pay the reasonable costs of a replacement hearing device 5 years after the initial fitting if the replacement is reasonable and/or necessary. Prior written approval is required for the supply of a replacement hearing device.

A request for a replacement hearing device should follow a hearing needs assessment undertaken by a hearing service provider at which the adequacy of the existing hearing device(s) is assessed. In addition to diagnostic testing, the hearing service provider should obtain information about the worker's current communication, functional and clinical status and whether this has changed since the provision of the current hearing device(s).

The hearing service provider must supply the agent with the following before a decision can be made on a replacement hearing device(s).

• The date the worker contacted the hearing service provider and the reasons given by them for requesting a replacement hearing device.
• Confirmation of the date the worker attended a hearing needs assessment with the hearing service provider
• Details of the worker's current communication, functional and clinical status and whether this has changed since the provision of the current hearing device(s).
• A ‘Hearing assessment and device request form’ or ‘Hearing assessment and device exception request form’ signed by the worker at the hearing needs assessment.

WorkSafe will consider the following when deciding whether to pay for a replacement hearing device.

• Whether the current hearing device continues to meet the worker's needs.
• Evidence of the worker's use of the existing hearing device over the previous 5 years. The agent may request the data log from the worker’s current hearing device.
• The current nature and circumstances of the worker's hearing loss and/or tinnitus and its relationship to work.
• The hearing service provider's assessment of the worker's current communication, functional and clinical needs.
• The worker's reasons for requesting a new hearing device.
• The clinical justification for the make, model and features of the requested replacement hearing device.
• Any changes to the worker's hearing since the previous hearing device was supplied.
• Whether the proposed hearing device is on the approved list or separate approval is required due to exceptional circumstances.

Early replacement of hearing devices

WorkSafe can pay the reasonable costs of a replacement hearing device within 5 years of the initial fitting of a hearing device if the following applies.

• The worker's hearing has changed significantly.
• The existing hearing device is no longer suitable and cannot be adjusted to meet the worker's current hearing needs.

When considering a request for early replacement, WorkSafe will consider the following.

• The clinical justification for the requested hearing device.
• Whether it will meet the worker's needs for the next 5 years.

A hearing device fitting package fee may apply where early replacement is approved.

Lost or damaged hearing devices

WorkSafe can pay the reasonable costs of a replacement for a lost or damaged hearing device only once within 5 years of the fitting of a hearing device. The loss or damage must be explained in a statutory declaration and not be covered by the manufacturer or supplier warranty or the worker's insurance.

WorkSafe will not replace a hearing device which has:

• not been used, maintained and stored in accordance with the manufacturer's instructions
• been wilfully damaged or destroyed
• been used by persons other than the worker.

If WorkSafe accepts liability for a lost or damaged hearing device, it will pay for a replacement hearing device that is identical to the approved lost or damaged hearing device.

WorkSafe will consider paying for a different hearing device if an identical device is not available, or the lost or damaged hearing device was provided more than 12 months previously.

WorkSafe will not pay a hearing device fitting package fee for replacement hearing devices that are identical to the lost or damaged hearing device.

WorkSafe will consider paying the reasonable costs of the applicable excess only where a lost hearing device is covered by a manufacturer's loss and damage warranty, or any insurance the worker may have that could cover the replacement device.

Who can provide these services

Hearing services and devices are delivered by providers who are approved and registered with WorkSafe to provide these services.

WorkSafe recognises contracted and non-contracted hearing providers. Contracted hearing providers are part of a hearing practice that has entered into a contract with WorkSafe following a successful tender submission. Non-contracted and contracted providers each have a different fee schedule.

WorkSafe will fund only hearing services and devices delivered by providers that meet the following conditions.

• Are registered with and approved by WorkSafe to provide hearing services.
• Audiologists must hold a Master of Clinical Audiology (MCAud) or equivalent.
• Audiometrists must hold one of the following:
  • Certificate IV in Audiometry (before 2008)
  • Diploma of Hearing Device Prescription Evaluation (after 2008)
  • Certificate IV in Audiometric Assessment (after 2008).
• Hold accredited membership with Audiology Australia (AudA) or a Certificate of Clinical Practice from ACAud inc. HAASA.
• Hold the requisite insurance coverage to deliver hearing services.
• Provide documented proof that facilities and equipment meet the required standards and that equipment is fully maintained and calibrated. This includes ambient noise level certificates valid for 3 years and equipment calibration certificates valid for 12 months. For contracted providers, ambient noise level certificates must be provided every 3 years, and equipment calibration certificates must be provided every 12 months.

Service delivery expectations

WorkSafe expects that all providers delivering hearing services and devices as part of the Victorian workers compensation scheme follow these principles.

• Provide culturally safe and respectful services.
• Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to an appropriate regulatory or complaints body.
• Support the person to maximise their independence, promote recovery and self-advocacy.

WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the Clinical framework.

WorkSafe has reporting and engagement expectations for all providers delivering hearing services and devices to workers. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.

For example:

• Providers should work with treating health practitioners or other providers, such as medical practitioners to enable the most appropriate treatment.
• Providers should work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.

Providers are required to comply with the requirements set out in these guidelines and in the ‘Application for registration to provide services to workers’.

If a provider does not meet these requirements or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the legislation.