Covers all medical and related treatment and hospital/ambulance costs reasonably necessary as a result of the injury. Most medical and related expenses require prior approval.

Fees for many services are covered by fee schedules.

s59 ,  60 ,  60A ,  61 ,  62 and  63 of Workers Compensation Act 1987.

Covered under medical and related treatment.

Reasonably necessary domestic assistance covered if a medical practitioner certifies it is required and the worker performed the task before the injury.

It is available for 6 hours/week for cumulative 12 week period or longer if the injury has resulted in at least 15% permanent impairment.

s60AA of 1987 Act.

Other costs covered under medical and related treatment, (e.g. domestic assistance, home and vehicle modifications etc), hospital treatment and workplace rehabilitation service as defined in  s59 of the 1987 Act.

Medical benefit entitlement period:

• All workers are entitled to at least 2 years of medical benefits from when weekly  payments cease being payable or from the date of claim if no weekly payments are made.
• Further time frames are: 5 years from when weekly payments cease to be payable for those with 11-20% permanent impairment or for life for those with greater than 20% permanent impairment.
• Some medical treatment and services are exempt from this compensation period limit. See  s59A , 1987 Act. Maximum fee rates  for allied health providers, medical practitioners; public, private hospitals and ambulance apply.
• s61(2) of  the 1987 Act

All reasonable costs for road accident rescue services, medical, hospital, nursing, personal and household, occupational rehabilitation and ambulance services received because of the injury —  s224(1) , Workplace Injury Rehabilitation and Compensation Act 2013

Reasonable costs is defined in  s223(2) 

For more information go to the  Online Claims Manual 

Attendant care is covered under the definition of ‘personal and household services’ in  s3 .

When making an assessment of an attendant care program consideration needs to be given to the worker’s:

• abilities
• degree of self-reliance
• accommodation needs
• extent of family support, and
• family’s need for respite.

Personal and household services are defined in  s3 and payable under  s224(1) 

In determining entitlement for personal and household services the individual circumstances of the worker need to be assessed having regard to:

• the reasonableness of the cost of the service, and
• whether  the service is necessary in the circumstances.

WorkSafe Victoria can pay the reasonable costs of home or car modifications reasonably required as a result of a work related injury where approval is given before the costs are incurred —  s231 

WorkSafe Victoria is liable to pay the reasonable costs of modifying the car, or if the car is not capable of being modified, to contribute a reasonable amount to the purchase cost of a suitably modified car.

WorkSafe Victoria is liable to pay the reasonable costs of modifying the home, or if the home cannot be reasonably modified, to contribute a reasonable amount towards the purchase costs of a semi-detachable portable unit or the costs of relocating the worker to another home that is suitable.

WorkSafe Victoria may issue guidelines identifying services or classes of services for which approval should be sought from WorkSafe Victoria before the services are provided —  s224(2) 

Entitlement to medical and like services ceases 52 weeks after the entitlement to weekly payments cease, or if compensation is only payable for medical and like services, 52 weeks after entitlement commenced unless certain circumstances apply —  s232 

If a worker’s injury is severe ( s223 ) for which immediate inpatient treatment in a hospital is received or results in death, family members are eligible for counselling services —  s224(1)(b) . Maximum family counselling expenses are $7,550 from 1 July 2023.

The insurer must pay the cost of the medical treatment or hospitalisation that the insurer considers reasonable having regard to the worker’s injury. Under the table of costs, WorkCover may impose conditions on the provision of the medical treatment —  s210 , Workers’ Compensation and Rehabilitation Act 2003.

The insurer must pay the costs that it accepts as reasonable, having regard to the relevant table of costs, for medical treatment by a registered person ( s211 ).  The Table of costs is published by WorkCover Queensland. The Insurer must pay the fees or costs of rehabilitation that the insurer accepts to be reasonable, having regard to the worker’s injury —  ss222 &  223 .

NIIS

The insurer must pay treatment, care and support payments to an eligible worker (who has sustained a serious personal injury that meets the eligibility criteria in  Part 5A of the Workers’ Compensation and Rehabilitation Regulation 2014) during their eligibility period under Chapter 4A (which can be for the workers’ lifetime). Treatment, care and support payments are for the worker’s necessary and reasonable treatment, care and support needs resulting from the injury. These needs are for ( s232J )

• medical treatment
• hospitalisation
• dental treatment
• rehabilitation
• ambulance transportation
• respite care
• attendant care and support services
• aids and appliances other than ordinary personal or household items
• prosthesis
• education or vocational training
• home, transport or workplace modifications

Under  s232O , an insurer must also provide the worker with a support plan on their treatment, care and support needs.

The worker may receive treatment, care and support payments for an eligible injury via an insurer’s funding agreement or response to a payment request ( s232Q ).

A funding agreement is between the eligible worker and their insurer for the payment of particular expenses to be incurred for the treatment, care and support for the worker in a stated period ( s232Q ).

A payment request is a written request by an eligible worker for an expense relating to their treatment, care or support to be paid or partly paid by an insurer ( s232Q ). An insurer is not liable to pay a payment request that exceeds an amount prescribed by regulation for the treatment, care or support ( s232R(4) ).

Part 5A Division 2 of the Workers’ Compensation and Rehabilitation Regulation 2014 specifies the assessment process for assessing a worker’s needs.

As above for Act references. Insurer decision on a case by case basis with respect to funding these services. Home Nursing services are listed under the  Nursing services table of costs 

NIIS

Attendant care is included in the definition of treatment, care and support needs ( s232J ) and may be the subject of treatment, care and support payments from an insurer.

Under  s117R of the Workers’ Compensation and Rehabilitation Regulation 2014, the insurer must obtain and consider information regarding home, transport or workplace modifications from a person who is appropriately qualified to provide advice on the needs. The insurer must also refer to the appropriately qualified person when considering attendant care and support services to assist a person to participate in the community. S  232K(2)(b) of the Act prescribes a registered provider must provide home modification, workplace modification or a service for the coordination of treatment, care or support.

Insurer decision on a case by case basis with respect to funding these services. Domestic assistance covered under the  Support Services table of costs .

Act  s224 . A caring allowance may be paid if the insurer is satisfied — the worker depends on day to day care for the fundamental activities of daily living; and the care is to be provided to the worker at the worker’s home on a voluntary basis by another person in relation to whom compensation is not payable.

NIIS

Attendant care is included in the definition of treatment, care and support needs ( s232J ) and may be the subject of treatment, care and support payments from an insurer.

As above for s  232K(2)(b) of the Act.

The insurer must pay the cost of the medical treatment or hospitalisation that the insurer considers reasonable having regard to the workers injury. Under the table of costs, WorkCover may impose conditions on the provision of the medical treatment ( s210 of the Act).

The insurer must pay the costs that it accepts as reasonable, having regard to the relevant table of costs, for medical treatment by a registered person ( s211 ). The Table of costs are published by WorkCover. The Insurer must pay the fees or costs of rehabilitation that the insurer accepts to be reasonable, having regard to the worker’s injury —  ss222 &  223 .

NIIS

Home and workplace modifications are included in the definition of treatment, care and support needs ( s232J ) and may be the subject of treatment, care and support payments from an insurer.

As above for s  232K(2)(b) of the Act.

As above for Act references. Insurer decision on a case by case basis with respect to funding these services. Home Nursing services are listed under the Nursing services table of cost published by WorkCover.

NIIS

An eligible worker’s eligibility period for treatment, care and support payments, ends when the worker dies or the worker stops being entitled to payments under Chapter 4A. Under  s232S , the worker’s entitlement to treatment, care and support payments ends if the insurer determines that their serious personal injury is not likely to continue to meet the eligibility criteria after the interim period ends.

Under  s232ZC , the worker’s entitlement to treatment, care and support payments for their injury ends if they accept an award of treatment, care and support damages.

Under  s232ZG an insurer may review and amend an approved support plan or service request to amend a worker’s approved services if the worker is leaving Australia.

Under  s232ZH , the insurer may suspend the worker’s entitlement to treatment, care and support payments if the insurer considers them affected by the worker’s absence from Australia.

Reasonable expenses incurred — Schedule 1,  clause 17 . Limited to 30% of prescribed amount ( $75,817 ). An additional $50,000 can be granted by an arbitrator where the worker’s social and financial circumstances justify it — Schedule 1,  clause 18A(1) 

If a worker meets an exceptional medical circumstances test and has a WPI of not less than 15%, they may apply for additional medical and related expenses capped at $250,000. Workers granted such an extension are excluded from seeking common law damages — Schedule 1,  clause 18A , Workers’ Compensation and Injury Management Act 1981.

Not prescribed in legislation. In special circumstances insurers may approve limited home and vehicle modifications.

Injured workers that require assistance from an approved vocational rehabilitation provider to assist them to return to work can access the entitlement for vocational rehabilitation expenses, which represents 7% of the prescribed amount (up to  $17,691 ).

There is no monetary limit defined in the legislation. However, there are limits on duration of support for medical and other expenses. If the worker is entitled to weekly payments for incapacity in respect of the injury, entitlement to compensation for medical and other expenses ceases 52 weeks after their entitlement to weekly payment ceases. If the worker is not entitled to weekly payments for incapacity, entitlement to compensation for medical and other expenses ceases 52 weeks after the claim —  s33(20) . Fees are regulated by gazette for hospital, medical and allied health services —  s33(11) 

Other costs may be reimbursed if reasonably incurred —  s33(1) .

A worker is entitled to compensation for reasonable expenses for constant attendance services necessarily incurred as a result of the injury —  s75(1)(a) .

Constant attendance services are services provided by a person other than a member of the worker’s family where the worker requires the regular or constant personal attendance of another person — ( s74 ).

Where there is any dispute in relation to constant attendance services, the Tribunal can make a determination as to: the necessity for the services, the period for which they are to be provided, and the level of payments that are reasonable and appropriate for those services —  s75(3 ).

A worker is entitled to compensation for reasonable expenses for household services necessarily incurred as a result of the injury —  s75(1)(a) 

Household services are services provided to the worker (other than by a family member) of a domestic nature and services required for the proper running and maintenance of the worker’s residential premises —  s74 

Where there is any dispute in relation to household services, the Tribunal can make a determination as to: the necessity for the services, the period for which they are to be provided, and the level of payments that are reasonable and appropriate for those services —  s75(3). 

A worker is entitled to compensation for reasonable expenses for rehabilitation services necessarily incurred as a result of the injury —  s75(1)(a) 

Rehabilitation services include any treatment, training or other assistance to facilitate or assist a worker’s rehabilitation, and necessary and reasonable modifications required to be made to the worker’s workplace, place of residence or motor vehicle. It also includes workplace rehabilitation services —  s74 

Where there is a dispute in relation to rehabilitation services, the Tribunal can make a determination as to: the necessity for the services, the period for which they are to be provided, and the level of payments that are reasonable and appropriate for those services —  s75(3) .

There is no monetary limit. However, there are limits on duration. If the worker is entitled to weekly payments for incapacity in respect of the injury, entitlement to compensation for medical and other expenses ceases 52 weeks after the lawful termination of weekly payments —  s75(2) 

If the worker is not entitled to weekly payments for incapacity, entitlement to compensation for medical and other expenses ceases 52 weeks after the date the claim was made —  s75(2AA) .

Compensation for medical and other expenses can be extended by Tribunal order —  s75(2AB). 

No monetary limit

If less than 15% WP impaired – 12 months after 260 weeks cessation of weekly benefits –  s61A 

If 15% or more WP impaired – no limit

Compensation is payable for attendant care services reasonably required —  s29(1) . This is generally from 28 days after the date of injury. If a catastrophic injury under  s29A there is no monetary cap for attendant care services.  s29(4) requires consideration of:

• nature of injury and degree that injury impairs ability to provide for personal care extent to which any  medical service or nursing care received provides for essential and regular personal care
• extent to which reasonable to meet any wish by the  employee to live outside an institution
• extent to  which attendant care services are necessary to enable the employee to undertake or continue employment
• any assessment made in relation to rehabilitation of the employee, or
• the extent to which a relative might reasonably be expected to provide attendant care services.

Compensation is not payable where an employee is residing in a nursing home or other similar place —  s29(3) . Comcare is liable to pay the lesser of $552.12 (statutory rate updated 1 July) or an amount per week paid or payable by the employee for those services.

Compensation is payable for household services reasonably required —  s29(1) . This is generally from 28 days after the date of injury. If a catastrophic injury under  s29A there is no monetary cap for household services and is available within the first 28 days.

s29(2) requires consideration of:

• extent to which household services were provided by the employee before the injury and extent to which  employee is able to provide those services after that date
• number of persons living with the employee as members of household, their ages and their need for household services extent to which household services were provided by the persons referred to in paragraph (b) before the injury
• extent to which the persons referred to in paragraph (b), or any other members of employee’s family, might reasonably be  expected to provide household services for themselves and for the employee after the injury, or
• the need to avoid  substantial disruption to the employment or other activities of the persons referred to in paragraph (b).

Comcare is liable to pay not less than 50% of the amount paid or payable by the employee no more than $552.12 (statutory rate updated 1 July).

• No limits on medical and  hospital  costs, all appropriate costs payable —  s16 .
• Other costs — no limits.

Compensation is payable for attendant care services reasonably required —  s43(4) . This service is generally not payable from 28 days after the date of injury. If a catastrophic injury under  s43A there is no monetary cap for attendant care services.  s43(5) requires consideration of:

• nature of the injury and the degree to which that injury impairs the worker’s ability to provide for their personal care
• extent to which any medical service or nursing service received by the employee provides for their essential and regular personal care
• extent to which it is reasonable to meet any wish by the employee to live outside an institution
• extent to which attendant care services are necessary to enable the employee to undertake or continue employment
• any assessment made in relation to the rehabilitation of the employee, and
• extent to  which a relative of the employee might reasonably be expected to provide attendant care services.

Compensation is payable for household services reasonably required —  s43(1) . This is generally from 28 days after the date of injury. If a catastrophic injury under  s43A there is no monetary cap for attendant care services.  s43(3) requires consideration of:

• extent to which household services were provided by the  employee before the date of the injury and the extent to which he or she is able to provide those services after that date
• number of persons living with the employee as members of their household, their ages and need for household services
• extent to which household services were provided to the employee before the injury
• extent to which members of the household might reasonably be expected to provide household services for themselves and injured employee, and
• the need to avoid substantial disruption to the  employment or other activities of persons in the household.

s51 

Where an employee is undertaking, has undertaken or completed a rehabilitation program or is assessed as not capable of undertaking a program, the following are payable if reasonable:

• costs of alteration of  employee’s residence or place of work
• modifications to a vehicle used by employee, and
• aids and appliances including repair or  replacement .

Attendant care — $552.12 per week

Household help — $552.12 per week, not less than 50% paid by employee, no more than $552.12 per week (1 July 2023).

Medical and hospital costs — no limits — appropriate costs —  s28 

Other costs — no limits.

Military Rehabilitation and Compensation Act 2004 (MRCA):

For ‘service related conditions’: all reasonable costs but not more than the amount actually incurred ( s288A ,  s288B ,  s288C &  s288F ).

Where a person has suffered a serious impairment from a service injury or disease ( s281 &  s282 ): all reasonable costs for all medical conditions but not more than the amount actually incurred.

Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA)

Medical treatment at a cost appropriate to that treatment —  s16 .

Liable to pay compensation for attendant care services reasonably required (MRCA  s219 & DRCA  s29(1) )

If a catastrophic injury under DRCA  s29A and MRCA 219(2) there is no monetary cap for attendant care services.

Without limiting the matters which can be considered when determining the reasonable requirements, the following matters are to be considered (MRCA  s218 & DRCA  s29(4) ):

• the nature of the person’s injury or disease,
• the degree to which that injury or disease impairs the person’s ability to provide for their personal care (MRCA only),
• the extent to which any medical service or nursing care received by the person provides for their essential and regular personal care,
• the extent to which the attendant care services are necessary to meet any reasonable wish by the person to live outside an institution,
• the extent to which attendant care services are necessary to enable the person to undertake or continue to undertake employment (including Defence service) (reference to Defence service in MRCA only) ,
• any assessment made in relation to the rehabilitation of the person,
• the extent to which a relative of the person might reasonably be expected to provide attendant care services.
• Any other matter the  Commission considers relevant (MRCA only)

Liable to pay compensation for household services reasonably required (MRCA  s216 & DRCA  s29(1) ).

If a catastrophic injury under DRCA  s29A and MRCA 216(2) there is no monetary cap for household services.

Without limiting the matters which can be considered when determining the reasonable requirements, the following matters need to be considered (MRCA  s215 & DRCA  s29(2) ):

• the extent to which household services were provided by the person before the service injury or disease,
• the extent to which he or she is able to provide those services after the service injury or disease,
• the number of other persons (household members) living with that person as members of their household, their ages and their needs for household services,
• the extent to which household services were provided by household members before the service injury or disease,
• the extent to which household members, or any other relatives of the person, might reasonably be expected to provide household services for themselves and for the person after the service injury or disease,
• the need to avoid substantial disruption to the work or other activities of the household members,
• Any other matter the  Commission considers relevant ( MRCA only).

Reasonable costs incurred in relation to purchase, loss of, or damage to, medical or rehabilitation aids or appliances (MRCA  s226 &  s56 , DRCA  s39 ).

Alterations to a person’s place of residence, education, work or service (MRCA  s56 DRCA  s39 ).

Reasonable costs of a vehicle’s modification (MRCA  s212 and  Motor Vehicle Compensation Scheme & DRCA  s39 ).

Reasonable costs of a vehicle’s purchase in some circumstances (MRCA  s212 and  Motor Vehicle Compensation Scheme   and DRCA s39(e) ).

Subsidy for purchase and modification of a vehicle and running and maintenance allowance through the Vehicle Assistance Scheme (VEA volume 3, part IV – allowances and benefits) s105 and  Vehicle Assistance Scheme Instrument.  

No limits on medical and hospital costs, all appropriate cost payable (DRCA  s16 & MRCA  Part   4 ).

No limit on attendant care services or household services reasonably required if deemed to have a catastrophic injury.

Satisfying the definition of catastrophic injury is not, however, a guarantee that individuals will receive higher levels of household and attendant care services. Those services will be provided on a needs basis subject to an assessment of individual circumstances.

DRCA definition  Safety Rehabilitation and Compensation (Defence-related Claims) (Catastrophic Injury) Rules 2018 

MRCA definition:  Military Rehabilitation and Compensation (Catastrophic Injury or Disease Determination 2018 

Otherwise the following limits apply:

MRCA

• Attendant care — $573.61 per week
• Household services — $573. 61 per week.

DRCA

Not less than 50% of the amount paid or payable by the employee and no more than the maximum rate  (s29 )

• Attendant care — $552.12 per week
• Household services — $552. 12 per week

Vehicle Assistance Scheme 

Maximum Initial vehicle grant $39,810.00. Can be more if Commission is satisfied provision of a more expensive vehicle is necessary because of accepted condition.

Maximum Replacement vehicle grant $19,905. Can be more if Commission is satisfied provision of a more expensive vehicle is necessary because of accepted condition.

Running and maintenance allowance 26 x  recreation transport allowance  

Schedule 1, Part 1,  s1 , Accident Compensation Act 2001. The Corporation is liable to pay or contribute to the cost of the claimant’ treatment for personal injury for which the claimant has cover if clause 2 applies,-

(a) to the extent required or permitted under an agreement or contract with any person for the provision of treatment; or

(b) if no such agreement or contract applies, to the extent required or permitted by regulations made under this Act; or

(c) if paragraphs (a) and (b) do not apply, the cost of the treatment.

In deciding whether to provide or contribute to the cost of attendant care, the Corporation must have regard to:

• any rehabilitation outcome that would be achieved by providing it
• the nature and extent of the claimant’s personal injury and the degree to which that injury impairs their ability to provide for their personal care
• the extent to which attendant care is necessary to enable the claimant to undertake or continue employment (including agreed vocational training) or to attend a place of education, having regard to any entitlement the claimant has to education support
• the extent to which household family members or other family members might reasonably be expected to provide attendant care for the claimant after the claimant’s personal injury
• the extent to which attendant care is required to give household family members a break, from time to time, from providing attendant care for the claimant, and
• the need to avoid substantial disruption to the employment or other activities of household family members — Schedule 1,  cl(14) .

Reimbursements: Schedule 1, Part 1,  17 Home help (1) In deciding whether to provide or contribute to the cost of home help, the Corporation must have regard to:

• any rehabilitation outcome that would be achieved by providing it, and
• the extent to which a claimant undertook domestic activities before the claimant’s personal injury and the extent to which he or she is able to undertake domestic activities after their injury, and
• the number of household family members and their need for home help, and
• the extent to which domestic activities were done by other household family members before the claimant’s personal injury, and
• the extent to which other household family members or other family members might reasonably be expected to do domestic activities for themselves and for the claimant after the claimant’s personal injury, and
• the need to avoid substantial disruption to the employment or other activities of the household family members, and
• the impact of the claimant’s personal injury on the contribution of other family members to domestic activities. Calculation: All assistance must be provided to meet an assessed, injury-based need. ACC is only responsible for providing the level of assistance required to achieve the planned rehabilitation outcome.

Limits: The Corporation is not required to pay for home help to the extent that home help continues to be provided after a claimant’s injury by a person:

• who lives in the claimant’s home or lived in the claimant’s home immediately before the claimant suffered their injury, and
• who provided home help before the claimant suffered their injury.

Social rehabilitation’ includes:

• aids and appliances
• child care
• educational support
• home modifications
• training for independence, and
• transport for independence (including vehicle purchasing and modifications).

All assistance must be provided to meet an assessed, injury-based need. ACC is only responsible for providing the level of assistance required to achieve the planned rehabilitation outcome.