The following information has been set up to provide Medical Practitioners with a guide to completing Workers Compensation forms and procedures.
The forms on the pages and the links were accurate as of August 2021.
We hope you will find this process helpful.
What is a Workers’ Compensation Claim?
A Workers’ Compensation claim is a claim pursuant to the Workers’ Compensation and Injury Management Act (WA) 1981 (the Act). It is what’s called a statutory claim. The system is a “no fault” system. That means that anyone can make a claim, irrespective of who caused the injury, provided that they are injured at work in the course of their employment.
What is an injury?
The act defines an injury as:
- a personal injury by accident arising out of or in the course of the employment, or whilst the worker is acting under the employer’s instructions; or
- a disease contracted by a worker in the course of his employment at or away from his place of employment and to which the employment was a contributing factor and contributed to a significant degree; or
- the recurrence, aggravation, or acceleration of any pre-existing disease where the employment was a contributing factor to that recurrence, aggravation, or acceleration and contributed to a significant degree.
A “personal injury by accident”, in the context of Workers’ Compensation, means any physiological change or disturbance of the normal physiological state. Such change or disturbance can be by way of sudden onset or a more gradual process.
A “disease” is defined by the Act as any physical or mental ailment, disorder, defect, or morbid condition whether sudden or gradual development.
An “aggravation… of any pre-existing disease” means that a pre-existing condition, even one that is not caused by an accident or injury, which was previously asymptomatic can still be an injury if the work environment or accident has caused it to become symptomatic.
What Forms are Required?
To make a Workers’ Compensation claim a worker needs to file a:
1. Workers’ Compensation claim form (WCCF), which the worker completes; and
2. First Medical Certificate (FirstMC) (First Certificate of Capacity Form 3), which is completed by a doctor.
WCCF can be found at : https://www.workcover.wa.gov.au/resources/forms-publications/worker-forms/
FirstMC can be found at : https://www.workcover.wa.gov.au/resources/forms-publications/health-provider-resources/#Certificates
It is very important that the WCCF and the FirstMC reflect the same information
| # | WCCF (completed by worker) | FirstMC (First Certificate of Capacity Form 3) (completed by doctor) | Comments |
| 1 | “Occurrence Details Date of Occurrence” | “4. Worker’s Description of Injury Date of Injury” |
These must match. If it is an injury that has been sustained over a period of time then either detail: |
| 2 | “Describe the Occurrence. Include: (i) what action was involved (ii) what object/machine/substance was involved. | “4. Worker’s Description of Injury … What Happened? |
These must match. If it is an injury that has been sustained over a period of time then use phrasings such as: |
| 3 | “Describe the Occurrence. Include: …. (iii) the most serious injury or disease caused (iv) the bodily location of the injury or disease | “4 Worker’s Description of Injury … Worker’s Symptoms” & “5 Medical Assessment … Clinical findings Diagnosis” | This should not be limited to the most serious injury but all injuries and symptoms. It is not uncommon for a worker to only complain about the most significant injury. This results in less significant injuries not being accepted as part of the claim. The insurer may deny treatment for the non-significant injury or, if the non-significant injury causes a work incapacity, may seek to stop workers’ compensation payments on the basis that the injury has not been accepted as part of the claim. |
The FirstMC (First Certificate of Capacity Form 3) and Progress Medical Certificates (PMC form 4A) are significant documents and can impact the worker’s claim if not completed properly.
PMC can be found at: https://www.workcover.wa.gov.au/resources/forms-publications/health-provider-resources/#Certificates
or download here
The “Work Capacity” section (section 6. On the FirstMC and section 5. On the PMC) are arguably the most significant sections.
Follow these rules:
- If “some capacity” is ticked the dates must be entered.
- If “modified or alternative duties” or “workplace modifications” is ticked you must detail the restrictions under the section “worker has capacity to:”.
· If “modified hours” is ticked you must stipulate the number of hours and days per week.
The amount of time required to complete the FirstMC and PMC and what insurers will pay.
A worker may require more than a short appointment to ensure that the FirstMC and subsequent PMCs are completed correctly.
Currently the insurers will pay based on the approved Work Cover WA rates.
Found at https://www.workcover.wa.gov.au/resources/rates-fees-payments/ Under Medical Fees and General Practitioners
Workcover WA fees as at 1 November 2020
Consultations
Surgery Consultation - in hours
| Content based; | Service Code | Fee* |
| Minor or Sprecific Service (Level A or B) | AA010/AA020 | $80.35 |
| Enabled Service (Level C) | AA30 | $146.75 |
| Comprehensive Service (Level D) | AA040 | $225.40 |
| Time Based | . | Fee* |
| Up to 5 mins | AA220 | $47.90 |
| more than 5 mins to 15 mins | AA230 | $62.40 |
| more than 15 mins to 30 mins | AA240 | $120.50 |
| more thatn30 mins to 45 mins | AA250 | $182.35 |
| more than 45 mins to 60 mins | AA260 | $247.05 |
What if the claim is not accepted or the insurer won’t pay the account and how can PPIL help?
Irrespective of whether the claim is accepted the worker must get the FirstMC and the PMCs as these are the primary documents that evident the work capacity.
If a worker is not able to get these then their claim is severely prejudiced.
If the claim is not accepted then the insurer will unlikely pay for the appointments.
What are the options?
1. Send it to Medicare
Medicare will accept invoices if the claim has not been accepted for 120 days.
“There can be a delay between when a bill is filed for the work-related illness or injury and when the workers' compensation insurance decides if they'll pay the bill. Medicare can't pay for items or services that workers' compensation will pay for promptly (generally 120 days). Medicare may make a conditional payment if the workers' compensation insurer denies payment for your medical bills pending a review of your claim
(Generally 120 days or longer).
If the state workers' compensation insurance denies payment, and if you give Medicare proof that the claim was denied, then Medicare will pay for Medicare-covered items and services.”
Further, at the end of every claim Medicare is sent 10% of the settlement amount by the insurer prior to the money being sent to the worker. Medicare will recover from the 10% the treatment that it has paid for, and return the difference to the client/patient.
2. Carry the debt until settlement of the claim.
In such circumstances PPIL will obtain an Irrevocable Authority from the client to ensure that your accounts are paid at the settlement of the claim
3. PPIL will pay for the costs of obtaining the FirstMC and subsequent PMC.
PPIL will pay for the costs of the appointments for the FirstMC and PMC (after the Medicare benefit has been paid).
Certificates of Capacity
On 1 July 2014, new Certificates of Capacity replaced the workers’ compensation medical certificates.
First Certificate of Capacity
- First Certificate of Capacity (PDF – 175kb)
- Explanatory notes – First Certificate of Capacity (PDF – 241kb)
Progress Certificate of Capacity
- Progress Certificate of Capacity (PDF – 187kb)
- Explanatory notes – Progress Certificate of Capacity (PDF – 409kb)
Final Certificate of Capacity
- Final Certificate of Capacity (PDF – 156kb)
- Explanatory notes – Final Certificate of Capacity (PDF – 238kb)
