Unerstattete oder verlorene Ansprüche bei WorkCover- und ICWA-Fällen

Definition

WorkCover processes require the injured worker to notify the employer promptly and for the employer to lodge the workers’ compensation claim with the insurer, who then assesses the claim based on medical reports and other documentation.[3] State schemes impose time limits for lodging claims (e.g. 30 days to 12 months depending on jurisdiction), after which entitlement can be reduced or denied.[3] Chiropractors treating such patients depend on the employer/insurer having a valid claim in time and on the clinic submitting correct treatment plans and invoices to be paid.[1][3] For ICWA motor vehicle accident claims, the chiropractor must sight the ICWA claim number, HICAPS treatment number and approval documentation before billing, or the patient must pay privately and seek reimbursement later.[1] In practice, some courses of treatment are started before full verification, referrals expire (e.g. DVA re‑referral required every 12 visits/12 months), or paperwork is incomplete, leading to insurers rejecting invoices and the clinic either writing off the debt or pursuing the patient, who may be unwilling or unable to pay. Logic‑based estimate: if 1–2% of insurer‑funded consults per year (e.g. 50–100 of 5,000 consults at ~AUD 70–80 per consult) end up unreimbursed due to administrative failure, the revenue leakage is ~AUD 3,500–8,000 annually.

Why This Matters

The Pitch: Chiropractic clinics in Australia 🇦🇺 lose schätzungsweise AUD 3,000–10,000 jährlich an nicht erstatteten WorkCover- und ICWA-Leistungen. Automatisierte Anspruchserfassung, Dokumentenprüfung und Fristenkontrolle reduziert diese unbezahlten Konsultationen deutlich.

Affected Stakeholders

Practice owner, Chiropractor, Accounts receivable clerk, Practice manager

Related Business Risks