What WorkSafe will pay for
A WorkSafe Agent can pay the reasonable costs of treating health practitioner (THP) reports when requested by an Agent in order to determine a worker's eligibility for initial or ongoing entitlement or ongoing entitlements under Victorian workers compensation legislation (the legislation).
THP reports can also be requested from the Accident Compensation Conciliation Service (ACCS), the Medical Panel and other legal representatives in accordance with dispute resolution processes under the legislation.
What is a treating health practitioner?
WorkSafe defines a treating health practitioner as a medical practitioner or an allied health service provider. However, not all allied health service providers are authorised to provide reports for workers.
What is a THP report?
A THP report is a report requested by an Agent for completion by a treating health practitioner authorised to report on services and clinical information relating to a worker’s work related injury or illness.
A THP report will provide information to assist in:
- determining a worker's eligibility for initial or ongoing entitlements
- reviewing a worker's ongoing medical and health services
- the management of a worker’s rehabilitation and return to work
What information is required in a THP Report
Treating health practitioners will receive a customised request for a report. They are requested to answer each specific question relevant to the worker’s claim. If a THP Report includes questions that are not applicable or are unable to be answered, then this should be documented in the report.
Depending on the purpose of the report request, the treating health practitioner may be asked to include information regarding the worker’s history, diagnosis, prognosis, progress, outcomes, capacity for work and medical management.
Who an Agent may request to complete a THP report
An Agent may request a THP report from the following providers who must be registered to provide services to workers:
- Medical Practitioner
- Network Providers
- Occupational Physiotherapist
Where an Agent has not authorised the provision of a report by the specific THP discipline, the request for a report should be directed to the referring medical practitioner.
Specific Guidelines for General Practitioner, Osteopathy and Chiropractor Reports
General practitioners (GPs), osteopaths and chiropractors will be requested to complete one of several different types of report templates depending on the complexity and stage of the claim:
- short report – Contains up to three questions (GP only)
- standard report – contains up to six questions
- comprehensive report – Contains seven to ten questions (GP only)
- other specific reports (GP only)
Examples of other specific report requests include the mental health eligibility report and the Medical Practitioner return to work questionnaire.
THP reports for other disciplines are currently under development.
How long a treating health practitioner has to return the THP report
The THP report should be returned to the relevant Agent within 14 days of the request. If a treating health practitioner is unable to complete the report within this time, they should contact the Agent.
How often can a THP report be requested?
A standard or comprehensive THP report should be requested no more than once per year, excluding exceptional circumstances.
Will treating health practitioners need to obtain a worker's consent prior to completing a THP report?
By signing the authority to release medical information section of the Worker's Injury Claim Form, a worker consents to any person who provides a medical service in connection with an injury/condition to which the claim relates to give information regarding the service relevant to the claim to the Agent.
Can an Agent release THP reports?
WorkSafe will release a THP report upon receipt of a written request from an worker or their legal representative. WorkSafe may then release the report to the specified party who must be either:
- a worker
- a worker's legal representative
- a worker's treating practitioner, or
- the Accident Compensation Conciliation Service (ACCS), where the report is relevant to a conciliation request lodged by the worker
An Agent can pay the invoiced amount where the THP report invoice is in accordance with the relevant WorkSafe treating health practitioner fee schedule for general practitioner, osteopath and chiropractor reports. For all other THP reports the Agent can pay the reasonable fee for that report.
Can an Agent pay for the cost of a consultation used for the purposes of preparing a THP report?
When a report is requested it is expected that it is completed on the basis of clinical notes. A consultation is not generally expected to be required for the preparation of the report.
Can an Agent pay for copies of clinical notes from treating health practitioners?
An Agent can pay for copies of clinical notes from treating health practitioners when specifically requested by an Agent. Clinical notes from a treating health practitioner will be paid in accordance with the Health Records Regulations 2002 and the Health Records Act 2001.
When will an Agent not pay for a THP report?
An Agent will not pay for a THP report:
- when the report is a copy or reissue of a previous report
- prior to the provision of the report (unless by agreement with the Agent)
- where the THP only provides a copy of their clinical notes
- when the THP Report invoice does not meet the WorkSafe minimum invoicing guidelines
An Agent will not pay the invoiced amount where the THP report has not been invoiced in accordance with the relevant WorkSafe treating health practitioner fee schedule. Where a fee schedule does not exist, payment will not be made if the fee is not considered reasonable for that report.