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WorkCover & Mental Health Plans — can a patient access both?
The question every GP gets and nobody has a straight answer for: “I’m on WorkCover — can I also get a Mental Health Treatment Plan?” Here is the decision framework, with the billing rule that matters.
The one rule that governs everything
You cannot claim Medicare for a service that is covered by workers compensation for the same condition.
Under the Health Insurance Act 1973 (s. 19(2)), Medicare benefits are not payable for a service where the patient is entitled to compensation (including workers compensation) in respect of the injury or illness to which the service relates. This means:
Same condition, same service → WorkCover pays. Not Medicare. No MHTP billing.
Different condition (unrelated to the work injury) → Medicare MHTP can apply for the non-work-related condition.
WorkCover claim rejected or not yet accepted → Medicare can be used in the interim, but if the claim is subsequently accepted, Medicare may seek recovery of benefits already paid.
Quick decision check
What is the patient's situation?
Practical GP workflow
Step 1: Identify the condition
Ask yourself: “Is this mental health presentation arising FROM the work injury/workplace, or is it independent of it?”
Step 2: Document clearly
Your clinical notes must distinguish between the work-related condition and any separate condition. This protects against compliance audits and supports the patient if either pathway is questioned. Record:
The nature and onset of the mental health condition
Whether it is causally related to the accepted work injury
Which funding pathway is being used and why
Step 3: Choose the correct referral pathway
WorkCover pathway: Issue a WorkCover certificate of capacity + WorkCover referral to psychology. This is NOT a Medicare MHTP. WorkCover funds the sessions directly — no session cap equivalent to Medicare’s 10 sessions (the insurer determines the number based on recovery needs).
Medicare MHTP pathway: Prepare an MHTP (items 2715 / 2717) + referral to psychology. Patient gets up to 10 individual + 10 group sessions per calendar year under Better Access.
Both pathways simultaneously (different conditions): Patient can have a WorkCover referral for the work-related condition AND an MHTP for a separate, unrelated mental health condition — but these must be clearly documented as distinct conditions, ideally with different treating psychologists to avoid any appearance of double-dipping.
Common scenarios
Patient has workplace bullying → anxiety. WorkCover accepted. Wants MHTP.
The anxiety IS the WorkCover condition. WorkCover funds psychology for this. You issue a WorkCover referral, not an MHTP. Medicare MHTP is not billable for this condition while WorkCover is covering it.
Patient broke their arm at work. Now depressed from chronic pain and time off. WorkCover accepted for the arm.
The depression is secondary to the work injury. In most states, psychological injury arising from a physical work injury can be included in the WorkCover claim — contact the insurer to add the psychological component. If added, WorkCover funds psychology. If the insurer declines to add the psychological component, Medicare MHTP may be appropriate — document the insurer’s decision.
Patient is on WorkCover for a back injury. Has longstanding depression predating the work injury.
The pre-existing depression is a separate condition, unrelated to the compensable injury. Medicare MHTP can apply for the depression. Document clearly that the two conditions are distinct. Ideally different psychologists to avoid confusion.
WorkCover claim is pending. Patient needs psychology now.
Medicare MHTP can be used in the interim. However, if the WorkCover claim is subsequently accepted and backdated, Medicare may seek recovery of benefits already paid. Document that the MHTP was issued because the WorkCover claim was not yet determined. Many WorkCover schemes also fund provisional/early treatment while the claim is being assessed — check with the insurer.
WorkCover claim was rejected. Patient still needs mental health support.
If there is no compensable entitlement, Medicare MHTP applies as normal. Prepare an MHTP, refer under Better Access. The patient may also choose to appeal the WorkCover decision — the MHTP does not prevent an appeal.
WorkCover has closed the claim or stopped funding psychology.
Once WorkCover entitlement has ended and the patient is no longer entitled to compensation for the condition, Medicare MHTP can be used. Document that the WorkCover entitlement has ceased.
State-by-state scheme names
The rules above apply nationally (the Health Insurance Act is Commonwealth legislation), but each state has a different workers compensation scheme with different terminology, session limits, and approval processes:
QLD: WorkCover Queensland — GP issues Work Capacity Certificate + referral. Initial 5 psychology sessions pre-approved; insurer sets timeframe.
NSW: icare / SIRA (replaced “WorkCover NSW” in 2015) — Certificate of capacity + psychology referral. SIRA-gazetted fee schedule (indexed Feb 2026).
VIC: WorkSafe Victoria — Certificate of capacity + referral. Treatment must meet Clinical Framework criteria. TARP case conferences for complex cases.
SA: ReturnToWorkSA
WA: WorkCover WA
TAS: WorkSafe Tasmania
ACT: ACT Default Insurance Fund
NT: NT WorkSafe
Federal: Comcare (APS, CSIRO, Australia Post, NBN Co, etc.)
Practical tip: When in doubt, call the insurer. Each scheme has a case manager assigned to the claim. The case manager can confirm what treatment is funded, how many sessions, and what documentation is needed. This is faster and more reliable than trying to interpret the legislation yourself.
General information only. This page provides a decision framework for the intersection of workers compensation and Medicare mental health services in Australia. It does not constitute medical, legal, or billing advice. The interaction between Commonwealth Medicare legislation and state/territory workers compensation schemes involves complex legal and clinical considerations. When in doubt, contact the patient’s WorkCover insurer case manager and/or Services Australia. Document your clinical reasoning for whichever pathway you choose.