- Compensable medical and related treatment expenses must meet a new “reasonable and necessary” test, with greater emphasis on clinical evidence, injury connection, and value for money.
- Applies to future treatment requests for both new and existing claims, and for both exempt and non-exempt claims through SIRA regulations and guidelines.
- Decision-makers will consider:
- Connection between the worker’s clinical presentation and treatment goals.
- Evidence of expected benefits.
- Previous treatment outcomes.
- Alternative treatment options (where relevant).
- Availability of a treatment in the broader community does not automatically make it compensable.
Treatments and services excluded from funding
- Alternative health treatments (e.g., aromatherapy, crystal therapy, and similar services).
- Wellness and life coaching services (including wellness retreats).
- Energy and healing practices (e.g., rapist therapy and shamanic healing).
- General health, fitness, social, or recreational activities.
- Changes also affect companion animals (see below).
Companion animals and transitional provisions
- From 1 July 2026, ongoing costs for companion animals (e.g., food, routine veterinary expenses) are no longer funded.
- Workers already receiving approved companion animal services before 1 July 2026 will continue to receive those benefits.
- Protection applies only to the companion animal and services already approved before 1 July 2026; any new companion animals or services are assessed under the updated rules.
- Transitional provisions may allow some existing treatment arrangements to continue for a period after commencement on a case-by-case basis; workers will be informed.
- Reforms aim for evidence-based, clinically justified, injury-focused, value-for-money treatment; the aim is not simply to reduce costs.
Excess rules for weekly payments
- Excess changes have been in effect for a few months; some employers are still adjusting.
- Applicability: references included “after 4pm June 2036” and “covered by a policy renewed on or after 4pm on 30 June 2026.”
- Excess payable amount equals the weekly compensation payments made to the worker in the first two calendar weeks after the worker becomes entitled to weekly payments (entitlement greater than $0).
- The excess period begins when incapacity commences and the worker has a weekly entitlement; this may be after the date of injury.
- Excess is the total of those first two weeks of weekly benefits and is not reimbursed if the claim is later declined (the initial obligation to pay remains).
- Payment method:
- If the employer pays weekly payments via payroll, the insurer reimburses the employer and deducts the excess from the initial reimbursement (preferred approach).
- Paying workers directly can strengthen workplace connection; research cited indicates connected workers return up to three times quicker.