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Home | Blog | What to do when your medical expenses entitlement is ending

1 July – end of medical expenses entitlement

For many long term injured workers, 1 July 2018 represents the end of the entitlement to claim medical expenses. A worker who suffered an injury prior to 1 July 2015 and was receiving income maintenance on that date has a maximum entitlement to 2 years further income maintenance (which ended on 28 June 2017) and then 12 more months of medical expenses (ending on or around 1 July 2018). The time is fast approaching for those workers, while for other injured workers the entitlement may have already ceased.

Exceptions

There are a few exceptions to the ending of the medical expenses entitlement, including future surgery, claims for a therapeutic appliance (e.g. hearing aid, prosthetic or eye glasses) or where a worker has undergone a permanent impairment assessment and is accepted a suffering at least a 30% whole person impairment (“WPI”). It is important that all injured workers obtain advice to determine if any of the exceptions apply as time limits apply in some cases.

Time limits

To make the most of the entitlement to claim medical expenses, all treatment, pharmaceuticals and surgery should, where reasonable and necessary, be obtained or undertaken during the entitlement period. Where this is not possible, in particular in relation to surgery required in the future, legal advice should be sought regarding an application to have the costs secured now for payment by the insurer at a time in future when the surgery is required. Time limits apply and it is important that a worker make the application to the insurer for pre payment of future surgery costs before the ending of the entitlement to claim medical expenses has elapsed otherwise the insurer has no obligation to pay for the surgery.

What are the alternatives?

When the entitlement to claim medical expenses ceases then alternatives for claiming should be considered, including through Medicare, a private health fund, the National Disability Insurance Scheme and/or privately funding the expenses, which may include through an award of lump sum compensation for permanent impairment for total and permanent disability. We can advise you on the best avenue for obtaining payment of medical expenses and on any claims for lump sum compensation, whether your entitlement to claim medical expenses is ending or has already ended. Either way, it is important that all injured workers obtain advice on their entitlements sooner rather than later.

Get in touch with us

To discuss your claim with one of our personal injury lawyers telephone our Adelaide office on 8213 1000 or submit a web enquiry.

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