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Injured Workers Compass Australia

My medical treatment has been denied.

Treatment approvals, second opinions, independent medical examinations and disputes.

Last reviewed

In one sentence

If treatment your doctor recommends is refused, ask for written reasons — refusals can often be reviewed.

What this means

Insurers generally pay for medical treatment that is 'reasonable and necessary' for your work injury. They may refuse treatment if they think it is not needed, not related to the injury, or not good value.

Insurers sometimes send you to an Independent Medical Examination (IME) with a doctor they choose. You usually have to attend, but you can ask for reasonable arrangements and you may be entitled to a copy of the report.

Your treating doctor can provide a report explaining why the treatment is needed. This is often the most important evidence in a dispute.

Things to know

  • Ask for the refusal and reasons in writing.
  • Ask your treating doctor or specialist to explain why the treatment is needed.
  • You can usually take a support person to an IME.
  • Urgent treatment disputes may have faster pathways in some schemes.

Common questions

Do I have to attend an IME?

Usually yes if the request is reasonable — refusing can affect your payments. You can ask about travel, timing and a support person.

Can I pay for treatment myself and claim later?

Sometimes, but there is a risk you will not be reimbursed. Get advice first, or use Medicare/private health and tell them it is a compensation matter.

What about psychological treatment?

Psychology and psychiatry are commonly covered for accepted psychological injuries, and sometimes for secondary conditions.

What you can do next

  1. 1Request the decision and reasons in writing.
  2. 2Ask your treating specialist for a supporting report.
  3. 3Lodge a review or dispute within the time limit.
  4. 4Contact a free legal service if the treatment is urgent.

General information only. Rules change and depend on your circumstances. Check with your regulator or get independent legal, financial or medical advice about your situation.