Doctors’ Workers Compensation Fees in NSW Explained

Workers’ compensation claims often involve medical treatment, but the way doctors’ workers compensation fees are set and paid in NSW is not always clear. There can be confusion amongst injured workers and employees around the fee structure and billing, which can lead to delays, disputes and unnecessary stress. This blog will explain the doctors’ workers compensation fees in NSW and break down how they are set, what services are covered, and what employers and employees need to know.

Doctors’ roles in the rehabilitation and workers compensation process

Doctors play a central role in the workers’ compensation and rehabilitation process, with their clinical guidance impacting recovery timelines, work capacity and return-to-work outcomes. When there is early medical intervention, injuries can be accurately diagnosed and treated before they worsen or become more complex. This may reduce the need for prolonged treatment, specialist referrals or extended time away from work, resulting in better health outcomes and more efficient use of medical costs.

Clear and consistent medical guidance from a doctor also supports effective suitable duties planning. When doctors are able to provide detailed information about work capacity, restrictions and expected progression, employers and rehabilitation providers can design duties that align with recovery. This reduces the risk of re-injury, delays or unnecessary medical appointments caused by unsuitable or unclear work arrangements.

Collaboration between doctors, employers and rehabilitation providers can ensure that positive outcomes are occurring from medical intervention. Open communication helps ensure treatment plans, workplace adjustments and return-to-work goals are aligned, supporting safer and more sustainable returns to work. When all parties work together, recovery is often faster, claims are better managed, and overall medical and claim costs can be minimised. Therefore, it is important for all involved in this process to understand doctors’ workers compensation fees so the appropriate consults and treatment can be organised for injured workers.

Fee structure and what is covered?

The below table details the fee structure for doctors’ workers compensation fees in NSW and also what is involved in each consultation level. Each consultation covers a variety of services, and they each increase in price based on their offering.

NOTE: Codes ending in ‘T’ are referring to consultations conducted via telehealth.

There are also some other additional relevant fees that are not a part of the consultations themselves but may need to be added on in some workers compensation appointments:

• Certificate of Capacity (initial) WC0001 – $56.20 plus GST (billed separately but commonly part of the first workers comp consultation).
• Additional time (beyond usual consultation) WC0002 – billed at $28.10 per 5 minutes plus GST for GPs, when related to recovery/return-to-work planning, meetings etc., with insurer approval. This includes case conferences.
• Other medical items WC0004 – Cost price (bandages, dressings, etc).
• Medical records WC0005 – $68.20 for electronic medical records. $43.30 for hard copy medical records of up to 33 pages, then $1.40 for each additional page. These fees include postage and handling.

What employers should know about doctors’ fees

In most workers’ compensation claims, doctors’ fees are paid by the insurer rather than directly by the employer. While employers are not usually responsible for paying medical invoices, medical costs still play a significant role in the overall cost, duration and outcome of a claim.

Additionally, appropriate and timely medical treatment can support faster recovery and earlier return to work, which helps reduce time away from work and associated claim costs. This is important as delays or disputes around treatment approvals can slow recovery, extend claim duration and lead to higher medical and wage-related costs over time.

It is also very valuable for employers to engage with doctors who are experienced in workers’ compensation. Practitioners who understand the workers’ compensation system, fee schedules and return-to-work requirements are more likely to provide clear, practical guidance on work capacity and suitable duties. This supports better decision-making, smoother claim management and more sustainable return-to-work outcomes, ultimately helping to control overall claim costs.