Work Cover Patients

What is a workplace accident and what is worker’s compensation?

Work accidents occur every day in the Australian work force and orthopaedic injuries can range from:

  • Overexertion through lifting, pushing and pulling
  • Falls, slips and trips
  • Repetitive motion injuries (eg typing)
  • Machine crushing and entanglement
  • Falling objects or debris

Workers compensation is a system to insure injured workers are fairly compensated for injuries sustained at work and this compensation can take the form of medical and rehabilitation costs, surgery, ambulance, medicine costs as well as physiotherapists, orthopaedic and ergonomic aids and other services to help you return to work.

What should I do if I have sustained an orthopaedic injury during my employment and need to see Dr Herald?
  • Call Dr Herald’s rooms for an appointment on 9233 3946
  • Bring a referral from your GP, hospital emergency doctor or other medical doctor along with your claims approval number. If you are a new work cover patient your claim will need to be first reported in your employer’s register of injuries and your employer will need to lodge a workcover claim through SIRA NSW (The State Insurance Regulatory Authority NSW). You will need this approval number to cover the cost of your surgery.
  • If it is an existing claim, please notify your case manager as they will need to be advised about treatments for funding approval

For more information please be advised that WorkCover now comes under three separate organisations WorkSafe NSW, SIRA and icare. Click here for more details and contact numbers )

If I have an open claim is my first consultation paid by my employer or insurer?

No. If you have an open claim be advised that you will FIRST require written approval (an approval number) from your insurance company or employer otherwise you will be charged at the time of consultation. Only in circumstances where the injury occurred in the last 24hours is approval not required and we will bill the employer directly.

If I have a written claims approval AND approval from the insurer does this mean my surgery is automatically covered? And will I have any out of packet gaps to pay?

If we have a claims approval number AND your claim has also been approved by the insurer, we will bill your insurer directly and you will not have any out of pocket gaps.

But please be advised that approval for surgery IS NOT AN AUTOMATIC process at your first consultation. After your consultation with Dr Herald, generally patients will be then sent for Independent Medical Examination (on behalf of the insurance company) before the surgical claim can be assessed and approved by the insurer.

Only once this claim is approved (generally this happens in 70 per cent of cases); will your surgery will be covered by your insurance provider.

If surgery is NOT approved by the insurance company, the patient may pay for the surgery themselves or in some cases obtain a solicitor and try to obtain approval through the legal system.

What will Dr Herald do in his work cover injury assessment?

Your assessment with Dr Herald will include:

  • A thorough physical examination and functional capacity assessment to determine the extent of your injury and what ongoing capacity you may have to work.
  • An outline of the mechanism of injury
  • The need for treatment, surgery or additional rehabilitation
  • Medical co-morbidities that are likely to impact on the management of your condition (in accordance with privacy considerations)
  • Dr Herald is very experienced in dealing with work related injuries and will optimise your recovery and ability to return to work quickly
  • Dr Herald is also a qualified permanent impairment assessment specialist often used by insurance companies to determine the capacity of impairment from work related injuries and not at fault injuries where there is insurance
What if I need longer to recover?

Dr Herald issues standard medical certificates but does not issue Certificates of Working Capacity for Work Cover patients. Patients will need to see their GP who writes their certificates, to update their certificate after surgery.

What useful links and forms will I need?

Attendant Care Form – for work injury patients

WorkCover NSW Certificate of Capacity – For work injury patients