1. Fees and payment

1.1 We do not bill WorkSafe or your agent directly

You pay Melbourne Hand Surgery in full at the time of your appointment. We will give you a receipt and an itemised invoice. You then claim reimbursement from your WorkSafe agent yourself.

1.2 You will not be reimbursed the full amount

WorkSafe pays according to its published fee schedules. Our fees are higher than the WorkSafe scheduled rate. The difference is your out of pocket cost.

WorkSafe's own guidance to injured workers confirms this: reasonable cost of treatment does not necessarily mean full payment, and where a provider charges more, the worker pays the difference.

Our fees are published at melbournehandsurgery.com/information-for-patients. Current WorkSafe rates are at worksafe.vic.gov.au.

1.3 Claiming your reimbursement

• Send your receipt to your WorkSafe agent.
• You must send receipts within 6 months of the treatment date.
• Once your agent receives the receipt, they must pay you within 30 days.

If you leave receipts longer than 6 months, you may lose the reimbursement entirely.

1.4 Surgery costs

If you proceed to surgery, there will usually be out of pocket costs for:

• the surgeon
• the anaesthetist (billed separately, by the anaesthetist)
• the surgical assistant, if one is required (billed separately)

Hospital and theatre fees are paid by your agent under the WorkSafe hospital fee schedules once surgery is approved.

You will be given a written estimate of Dr Tomlinson's surgical fees and the expected reimbursement before you consent to surgery. Please ask the anaesthetist's rooms directly for their estimate, or ask our administrative staff to request an anaesthetic fee estimate on your behalf.

2. Approval for tests and surgery

2.1 Approval must be obtained before, not after

Your agent must give written approval before elective surgery is performed. The same applies to most investigations. Without approval:

• WorkSafe will not pay or reimburse
• the hospital will not accept the booking, because the hospital requires the agent's letter confirming payment

2.2 What we do

When Dr Tomlinson determines that surgery is required, we will:

• prepare a written request containing the clinical information WorkSafe requires (diagnosis, description of the proposed surgery, clinical justification, MBS item numbers, hospital admission requirements, previous treatments, alternatives considered, expected outcomes, and reference to the relevant imaging)
• email it to your claims manager within 48 hours, if you have given us their email address
• give you a copy

2.3 What you do

• Give us your claim number and your claims manager's name, email and phone number. We ask for this on the registration form. If you do not provide it, we will give the request letter to you, and it is then your responsibility to send it to your agent.
• Follow up your claims manager yourself. Contact them to confirm the request was received, and again to ask for a decision.

2.4 What we do not do

We do not case-manage your WorkCover claim. Specifically, we do not:

• telephone or email your claims manager for progress updates
• escalate delays on your behalf
• act as your advocate with your agent, employer or the Accident Compensation Conciliation Service

This is not a service Melbourne Hand Surgery provides, and we are not able to influence how quickly your agent makes a decision.

2.5 How long approval takes

WorkSafe states that the majority of surgery requests will have an outcome within 28 days.

If you have not received a decision within 28 days of our request, contact your claims manager and ask for one.

We cannot control this, and we accept no responsibility for delays caused by your agent, your employer or WorkSafe, or for the consequences of those delays. Our responsibility is to prepare and email a complete request within 48 hours, and to give you a copy so that you can follow it up.

2.6 Urgent and emergency surgery

Prior approval requirements apply to elective (non-emergency) surgery. If you require genuinely emergency surgery, it will not be delayed while approval is sought. Payment is then resolved with your agent afterwards, and out of pocket costs may still apply.

3. Certificates of Capacity

3.1 Why they matter

You must have a valid Certificate of Capacity in force to continue receiving weekly payments. If a certificate lapses, your payments can stop.

• The first certificate can only be issued by a registered medical practitioner and is valid for a maximum of 14 days.
• Subsequent certificates can be issued by a medical practitioner, physiotherapist, chiropractor or osteopath, and are valid for a maximum of 28 days.

3.2 Occupational therapists cannot issue certificates

Under the WorkCover legislation, occupational therapists are not authorised to issue Certificates of Capacity, even when they are your primary hand therapist.

• If your hand therapist is an occupational therapist, you will need to see your GP every 28 days.
• If your hand therapist is a physiotherapist, they may be able to issue your ongoing certificates, provided a first certificate has already been issued by a doctor.

3.3 When Dr Tomlinson will issue a certificate

There are two situations:

Your first certificate. If you attend your initial appointment and tell us that no doctor has yet given you a first Certificate of Capacity, so you cannot start your WorkCover claim, Dr Tomlinson will issue one. Please raise this at the start of the appointment.

After surgery. Dr Tomlinson will issue a Certificate of Capacity at the time of your surgery, because your post-operative restrictions come directly from the operation.

This certificate will cover up to 28 days, but will often be issued for a shorter period, such as 7 to 14 days. This is deliberate. A shorter certificate means your capacity is reviewed sooner, so that you, your hand therapist and your workplace return to work coordinator can work together on returning you to safe alternative or modified duties as early as it is safe to do so. Returning to suitable work earlier is associated with better recovery outcomes.

3.4 Otherwise, your GP issues your certificates

Outside those two situations, Dr Tomlinson does not issue Certificates of Capacity, and does not issue them outside a consultation. Please see your GP every 28 days. This is deliberate, for three reasons:

• A Certificate of Capacity is a workplace capacity assessment, not only a medical opinion. It is most useful when based on a discussion about your actual job tasks and your therapy progress. Your GP and your hand therapist are better placed to do that than a surgical consultation.
• Dr Tomlinson does not see you every 28 days. Her review intervals are set by your surgical recovery, not by the certificate cycle.
• WorkSafe agents query unexplained changes of certifier. Continuity with one certifier, usually your GP, works in your favour.

Your 28-day GP appointment is also an opportunity to discuss your general health, pain management, mental health and overall recovery, which a hand surgery consultation does not cover.

3.5 Please plan ahead

Book your GP appointment before your current certificate expires. We cannot issue a certificate at short notice to cover a gap that has not been planned for.

4. Communication with your treating team

Dr Tomlinson writes a letter after every consultation. Letters are sent to your referring doctor, your GP, your hand therapist, and any others you nominate.

This is how your treating team stays informed. Please tell us at each visit if your GP or hand therapist changes.

5. Release of your information to WorkSafe

Your agent will routinely request your records, most commonly Dr Tomlinson's consultation letters. Your signed WorkCover claim form authorises this.

Our practice:

• We will notify you when we receive a request from your agent for your records, and confirm your agreement before we release them.
• If you do not want your information released to your agent, tell us in writing. We will comply.
• Withholding information from your agent is likely to affect your claim, including approval for surgery. Your agent may not be able to approve treatment without the clinical information supporting it.

6. If you have not yet lodged a claim

The sequence is:

1. Obtain a Certificate of Capacity. The first one must come from a doctor, usually your GP. If you have not been given one, tell us at your initial appointment and Dr Tomlinson will issue it.
2. Complete a Worker's Injury Claim Form.
3. Give the certificate and claim form to your employer.
4. Your employer lodges it with their WorkSafe agent.
5. The agent allocates you a claim number and a claims manager.

Victorian WorkSafe agents are Allianz Australia Workers' Compensation (Victoria) Limited, EML VIC Pty Ltd, Gallagher Bassett Services Workers Compensation Vic Pty Ltd, and DXC Claims Management Services (formerly Xchanging). A small number of claims are managed directly by WorkSafe. Current agent contact details are at worksafe.vic.gov.au/your-worksafe-agent.

We do not know which agent your employer uses, or who your claims manager is, unless you tell us.

We do not require you to have a claim number to be seen. Patients come to us at every stage of the claims process. But without a claim number and your claims manager's email address, we cannot lodge a surgery request on your behalf.

7. Summary of responsibilities