Medical expenses in a NSW workers compensation claim

Medical expenses

What the New South Wales workers compensation scheme pays towards treatment, why most of it has to be approved before it happens, and what can be done when an insurer declines something a doctor has recommended.

General information, not legal advice. This page sets out how the law generally applies. It does not take account of your circumstances, and you should get advice about your own situation before acting on it. The official sources this page is written from are listed on it; where they differ from anything here, they are the authority.

Last updated: 23 September 2026

If a doctor has recommended treatment for a work injury, the cost of it is usually dealt with by the insurer rather than by you. This page describes how that part of the New South Wales workers compensation scheme works: what it pays towards, why most treatment has to be approved before it happens, what happens when an insurer declines a request, and how long medical expenses remain payable.

It is written for someone who is already out of pocket, or who has been told that something their doctor asked for will not be funded. Most of what follows is procedural, and none of it depends on proving that anybody was at fault.

What the scheme pays towards

icare, which administers workers insurance in New South Wales, publishes medical and related expenses as one of the categories of payment available on a workers compensation claim, alongside weekly payments, lump sum compensation for permanent impairment and work injury damages.

The treatment side of a claim is broader than most people expect. icare describes it as covering:

Treatment by medical practitioners, and by physiotherapists, chiropractors, osteopaths, psychologists, counsellors and exercise physiologists.
Some hospital treatment, in a public or a private hospital.
Ambulance services, including emergency, non-emergency and inter-hospital transfers.
Workplace rehabilitation services.
Modifications to your home or your vehicle.
Travel expenses for getting to and from treatment.

Medical expenses are a separate entitlement from weekly payments. An insurer can accept one and dispute the other, and a decision about treatment is not a decision about anything else on the claim.

The test is whether the treatment is reasonably necessary

Compensation for treatment under the Workers Compensation Act 1987 (NSW) is not payable simply because a practitioner has recommended something. The treatment has to be reasonably necessary as a result of the injury. The Personal Injury Commission, which decides workers compensation disputes, describes whether medical treatment is reasonably necessary as one of the questions it determines.

In practice that test is answered on paper. What your nominated treating doctor writes, what a specialist’s report says, and what was recorded about the injury at the time tend to settle the question before anyone argues about it. That is why the certificate of capacity and the early records matter so much, and why it is worth reading what has been written about you rather than assuming it is right.

It is also worth being clear about what an insurer’s letter is. A decision not to fund treatment is a decision, not an opinion, and it takes effect unless it is reviewed or disputed.

Most treatment has to be approved before it happens

icare publishes that most medical treatment needs to be pre-approved by the insurer, and that normally this simply means your doctor or treatment provider needs to send a written request for approval. The request usually comes from the practitioner rather than from you, which means you may not see it, and it is reasonable to ask for a copy.

Some things do not need approval first. icare lists treatment provided in the short window immediately after the injury, consultation with the nominated treating doctor, and a limited number of physiotherapy, osteopathy or chiropractic consultations and of psychological treatment or counselling sessions.

No number of sessions and no approval period is printed on this page. Those figures are set by the scheme, published by icare and by the State Insurance Regulatory Authority, and changed from time to time. Take them from the source before you rely on them.

Treatment that needed approval and did not get it can end up as your bill. If you are not sure whether something is covered, ask the insurer in writing and keep the answer.

How the money actually moves

icare publishes that it will generally pay the hospital or the service provider directly, so that you are not out of pocket. Where that does not happen, or where you have already paid, the cost is claimed by way of reimbursement.

Travel to and from treatment can be reimbursed at a rate set by the scheme. icare asks you to keep a record of the kilometres travelled, or the receipts, before claiming. The rate itself is published by icare and is adjusted, so take it from there rather than from a page like this one.

If a provider asks you to pay for something yourself, ask the insurer in writing whether the service is approved and at what rate before you pay it. Keeping the invoices, the approval emails and the insurer’s letters together in one place is dull, and it is one of the most useful things you can do for a claim.

How long medical expenses stay payable

Medical expenses are not open ended. icare publishes information about section 59A of the workers compensation legislation, which limits how long compensation for medical expenses is payable once weekly payments stop being payable. The period is longer for a worker assessed with a higher degree of permanent impairment, and some categories of treatment sit outside the limit altogether.

No period and no impairment figure is printed here. Which one applies depends on your claim, on your assessed impairment and on when your weekly payments stopped, and this is one of the parts of the scheme currently being amended. icare publishes the current periods and the exceptions to them.

If your weekly payments have stopped, or you have been told they are about to, keep the letter that says so. It is usually the document a period runs from.

When the insurer declines something

An insurer’s decision on treatment is given in writing. The Personal Injury Commission publishes that workers who disagree with all or part of an insurer’s decision have the right to request a review by the insurer before lodging an application with the Commission, and that in some cases an internal review is required before a dispute can be lodged at all. It also publishes that before a dispute can be lodged, a claim must first have been submitted to the insurer.

Medical and related expenses compensation is one of the entitlements dealt with in the Commission’s legal pathway. An application is lodged through the Commission’s online Pathway Portal.

There is also an expedited pathway. The Commission publishes that expedited disputes are managed by a senior lawyer or member, and that where agreement is not reached at the preliminary conference the senior lawyer or member will issue an interim payment direction if the dispute is about weekly payments or medical expenses. Eligibility for that pathway depends, among other things, on the amount of compensation for medical expenses in dispute being no more than a published ceiling.

The insurer makes a decision and gives it to you in writing.
You ask the insurer for an internal review, which in some cases has to happen before anything else.
An application is lodged with the Personal Injury Commission through its Pathway Portal.
There is a preliminary conference. The Commission publishes that a substantial number of legal disputes are resolved at that stage.
If it is not resolved, a conciliation conference and arbitration hearing follow, and a member makes a legally binding decision.

There is more on what an insurer’s decision is and what can be done about one in the guide to when a decision goes against you. Where the argument is about whether the injury is covered at all rather than about the treatment, see liability disputes.

Time limits, and why no number appears here

Several different periods run through this part of the scheme: the time in which a review can be asked for, the time for which medical expenses remain payable after weekly payments stop, and the time for appealing a medical assessment. They are real, they are short, and they are strict.

Which of them applies to you, and when it started running, depends on the document you were given — the insurer’s decision letter, the notice about your weekly payments, or the medical assessment certificate. That is why no day count is published on this site. Take the period from your own document and from the current Act on the NSW legislation register, and get advice before a date passes rather than after one has.

If you think a period may already have run, that is a reason to ask sooner rather than to give up. Whether anything can be done about it turns on facts a web page cannot know.

This part of the scheme is being changed

The Personal Injury Commission publishes that the Workers Compensation Legislation Amendment Act 2025 and the Workers Compensation Legislation Amendment (Reform and Modernisation) Act 2026 were assented to in late 2025 and early 2026, and that the amendments deal with injury assessment, claims management, available entitlements and how disputes are decided. Changes commenced on 27 March 2026 and on 1 July 2026, and the Commission publishes that further changes are set to commence in October.

Its workers compensation pages currently carry a notice that the information is being updated and may change as the reforms are implemented. Anything you read about this scheme, on this site or anywhere else, is worth checking against the current Act and against the Commission’s own pages before you act on it.

Help that does not depend on this site

Many claims are dealt with directly with the insurer and never need a lawyer. The Commission publishes that it cannot provide legal advice, although it will assist with the procedural aspects of an application, and it points self-represented workers to the Independent Legal Assistance and Review Service for help finding representation, and to the Law Society of NSW and LawAccess NSW for referrals.

Legal Aid NSW publishes that the Independent Review Office is an independent body that deals with complaints by injured workers against insurers. LawAccess NSW is a free service run by Legal Aid NSW that provides legal information and referrals and, in some cases, advice. None of those services depends on anyone here.

If you would rather have the documents looked at, you can tell us what has happened. A short summary is enough to begin. Please do not send medical records before a conflict check.