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What happens if my WorkCover psychology treatment is not approved?
Quick answer: A decision not to approve a treatment request is not necessarily the end of the matter. These decisions can be reviewed, and your treating providers can supply clinical information to support that review. Your insurer can explain the reasons behind the decision and the review options available to you.
Being told that a treatment request has not been approved can be unsettling, particularly when you were counting on that support. It helps to know that this is often not a final answer, and that there are clear steps available from here.
It is not always a straightforward "no"
A request that is not approved does not always mean treatment has been refused outright. In many cases it reflects a need for further information before the request can be properly considered, such as additional clinical detail or an updated treatment plan. Where that is the situation, providing the missing information is often enough to move things forward.
The decision can be reviewed
If a request is not approved, that decision can be reviewed. Your insurer is the appropriate first point of contact, and they can explain the specific reasons for the decision and the review process that applies to you. From there, your treating providers can supply clinical information to support a review, including your psychologist, whose role is to set out your needs, the treatment recommended, and the clinical reasoning behind it. This gives any review a sound clinical basis to consider, so that decisions can be made on complete information. You are not expected to work through this on your own.
Frequently asked questions
A decision not to approve a treatment request is not necessarily final. Such decisions can be reviewed, and your treating providers can supply clinical information to support that review. Your insurer can explain the reasons for the decision and the review process available to you.
A request is not always declined outright. Often it reflects a need for further information, such as additional clinical detail or an updated treatment plan, before the request can be considered. In these cases, providing the missing information can be enough to move things forward.
Your psychologist can provide clear clinical documentation about your needs and the treatment proposed, which can support a review of the decision. Their role is to set out the clinical picture accurately, not to dispute the claim on your behalf.
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If you would like to discuss your psychological treatment, please call or email directly. All enquiries are handled personally.
This page is general information for people in NSW and is not personal, clinical or legal advice. Decisions and review processes depend on your individual claim. Your insurer can explain the reasons for a decision and the review options available to you.