Work-related stress: care and compensation

To the Editor: The editorial by Steven and Shanahan on work-related stress1 indicated that claiming Medicare benefits for a workers compensation injury is specifically precluded. It also identified a need for guaranteed certainty of cost reimbursement for treatment.

Medicare benefits are payable for professional services that are wholly covered by workers compensation, unless there is a reimbursment arrangement with the insurer.2 The patient may be bulk billed or given a private account. The recovery of any benefits paid once a settlement or judgement is made does not involve the practitioner.

It is not claiming the benefit which is precluded, but keeping it if an outcome favourable to the plaintiff ensues. My understanding is that unsuccessful claims are rebatable under Medicare for clinically relevant medical services. The medicolegal expenses incurred, for example for reports, do not qualify, as they are not medically necessary. The fees are a private matter, as are any treatment charges in excess of the Medicare rebate. Herein lies the uncertainty.