Elective surgery fact sheet

Type of surgeries

Elective surgeries could be:

• joint replacements - knee, hip, ankle, shoulder
• joint reconstructive surgeries - knee, ankle, shoulder
• fusion surgeries - spinal and peripheral joints
• internal organ surgery - hernias
• amputations - the removal of the whole or part of an arm, hand, leg or foot

It is your decision

Every surgery is different.

Every surgery can have positive and negative impacts.

WorkSafe makes elective surgery a high priority because it can be an important part of your recovery.

It is your decision to have any approved surgery.

WorkSafe can help pay for treatment

WorkSafe can cover the cost of elective surgery you need to recover from a work-related injury. Sometimes there is a gap between the total cost of surgery and the amount WorkSafe can pay under law. If this happens you might have to pay the difference yourself.

What happens if I need surgery?

If your doctor advises elective surgery could benefit you, the following steps must occur:

1. You and your doctor will develop a post-surgery recovery plan.
2. Your doctor will ask your WorkSafe agent to approve surgery. They will describe the potential benefits, your current diagnosis, previous and current treatments, and your recovery plan.
3. You might be asked to attend an independent medical examination so your agent can be sure the surgery is right for you.
4. Your agent will review your request against the medical benefits schedule and WorkSafe's policies and fee schedules. Not all surgery requests are approved. You can have any decision reviewed.
5. Most elective surgery requests will have an outcome within 28 days. Complex requests may require information from more than one source. This may add to the time it takes the agent to make a decision.
6. If your surgery is approved your doctor may ask you to pay a "gap" between what they charge and WorkSafe's fees.
7. If you are happy with the decision your surgery proceeds and your recovery plan begins.