Gym and swimming memberships policy

What WorkSafe will pay for

The WorkSafe Agent (the agent) can pay the reasonable costs of gym and/or swimming memberships when required for rehabilitation and functional restoration following a work-related injury. Once a worker's functional condition has stabilised, ongoing gym and/or swimming memberships can be helpful in maintaining general health and fitness, but will no longer be funded by the agent.

The agent can pay the reasonable costs associated with providing an injured worker with an appropriate program to follow for the injured worker to complete independently.

Initial Gym and/or swimming membership

To consider paying the reasonable costs of a three month gym and/or swimming membership, the agent requires:

• a completed three month gym/swim membership request form from the treating practitioner, including the injured worker's rehabilitation goals and baseline functional outcome measures

The agent may contact the referrer for further information about the request.

Subsequent gym and/or swimming memberships

To consider paying the reasonable costs of a subsequent three month gym and/or swimming membership, the agent requires from the treating practitioner (in addition to the membership request form):

• demonstration of progress against functional outcome measures over the course of the previous membership
• records of attendance for the previous membership

Once a worker's functional condition has stabilised, as demonstrated by stable scores from serial functional outcome measures, the program will become one of maintenance and the worker will be responsible for self-funding any ongoing or future memberships.

The agent will consider paying for assistance for a worker to attend a gym and/or swimming membership when required due to their work-related injury or illness in accordance with the Attendant care policy.

Definitions

In this policy:

Treating practitioner

A registered medical practitioner, physiotherapist, chiropractor or osteopath.

Gym and/or swimming membership

A three month membership to an appropriate gym and/or pool facility as defined below where the injured worker independently performs exercises as per the program developed by their treating practitioner.

• is a commercial gym and/or pool facility designed for public use or a gym and/or pool within the premises of a health professional
• is located in a practical location, within a reasonable distance of the worker's home or work
• is designed and equipped for various modalities of exercise, sports and physical training
• has suitable equipment to meet the needs of the worker as recommended by the referrer
• has suitably qualified staff to ensure worker safety
• is registered and approved by WorkSafe to provide remedial exercise services

Functional outcome measures

Tools used to assess a person's current or future health status and demonstrate the effectiveness of treatment. For more information on outcome measures and access to appropriate questionnaires.

Guidelines

When will the agent respond to a request?

Within 10 working days of receiving the request, the agent will advise whether:

• the request has been approved
• the request has been denied, or
• further information is required to make a decision

Where further information is required, the agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information.

What fees are payable for gym and/or swimming memberships?

The agent will not pay more than the facility's published rate for a three month membership and can pay the reasonable fees for a gym and/or swimming membership up to the maximum amount as specified in the WorkSafe Fee Schedule for Gym and Swimming Memberships.

In relation to gym and/or swimming memberships, what won't the agent pay for?

The agent will not pay for:

• memberships or services for a person other than the worker
• memberships or services requested by an exercise physiologist
• extra services offered by the facility, such as spa or sauna or yoga classes
• WorkSafe specific rates where there is a margin between the published rate available to the general public and the rate available to WorkSafe. WorkSafe will only pay the rate available to the general public.
• casual pilates/gym and swim sessions concurrently or in isolation, except where casual swim sessions are required as part of a supervised hydrotherapy program provided by a physiotherapist at a third party swimming centre
• personal trainers
• a gym and/or pool membership chosen by a worker because it offers extra services when there is a standard gym available – the worker is responsible for funding the difference in cost in such a case
• services where the costs are not considered reasonable
• a gym and/or swimming membership for the purposes of maintaining physical fitness once rehabilitation goals have been achieved
• gym attire, swimming costumes or addition equipment
• more than one gym and/or swimming membership at the same time
• treatment or services subcontracted to or provided by a non-registered provider
• fees associated with cancellation or non-attendance
• treatment or services provided outside Australia without prior written approval from the Agent