The information below is provided as a guide. For more specific information contact your Insurance Commission Claims Officer or Western Australia Police Health and Welfare Services.
Former Officers can seek advice from either the Insurance Commission or Western Australia Police. If a claim has been lodged, an Insurance Commission contact will be identified on correspondence. Alternatively you can contact us.
- The Former Officer completes the Claim Form and submits this to the Western Australia Police along with the Medical Certificate provided by the treating doctor and any other relevant information. The forms must be sent to:
Western Australia Police
Health & Welfare Services
Law Chambers Building
Level 5, 573 Hay Street
PERTH WA 6000
- Western Australia Police then completes the Western Australia Police section of the claim form and submits this form, along with medical certificates, accounts, witness statements (if applicable) and any other relevant information, to the Insurance Commission.
Former Officers and former Aboriginal Liaison Officers should ensure that the completed claim form is submitted to the Western Australia Police as soon as possible. This is essential to ensure that the Insurance Commission can promptly process and make a decision on the claim within the prescribed time frames.
Under the
Police (Medical and Other Expenses for Former Officers) Act 2008, you are not entitled to claim benefits under this scheme if you have previously received compensation for medical and other expenses related to the same injury or disease. This includes compensation received through:
- A common law action.
- Motor Vehicle Third Party Insurance.
- An Act of Grace payment.
- Criminal Injury Compensation.
On receipt of a claim form and other related documents, the Insurance Commission will assess and make a decision on liability in accordance with the
Police (Medical and Other Expenses for Former Officers) Act 2008 and notify the Former Officer and the Western Australia Police.
If a decision on liability is unable to be made within the prescribed period, the Insurance Commission will provide written reasons as to why liability is pended, stating the nature and substance of the further information that is required.
Some common reasons for liability being pended include:
- Further medical information is required.
- The Former Officer's medical authority or consent to obtain information is required.
- Further particulars of the injury circumstances is required.
For a claim received within:
- 6 months after the commencement of section 4(1) of the Act, up to 60 days after the claim is received.
- For all other claims, up to 17 days after the claim is received.
The Insurance Commission must provide a written decision (accept/pend/decline) on a submitted claim within the prescribed period.
A letter will be forwarded within the prescribed time frame advising on the liability decision. If the decision is to pend or decline liability, the Insurance Commission will provide a reason for that decision.
To assist the Insurance Commission determine liability, a Former Officer may be required to attend a medical practitioner for examination. The cost of the examination will be paid for by the Insurance Commission.
Once your claim has been accepted, accounts can be sent directly to the Insurance Commission at the following address:
Former Police Officers Medical & Other Expenses Scheme
Insurance Commission of Western Australia
GPO Box K837
PERTH WA 6000
If you have a claim number, please include this on all accounts and correspondence sent to the Insurance Commission or the Western Australia Police.
To avoid delays in payment, original accounts and receipts are required.
Depending on the service provider's billing practices you may be required to pay for medical services up front, and then claim it back from the Insurance Commission.
Once your claim has been accepted, service providers can send their accounts directly to the Insurance Commission for payment.
Former Officers may be required to submit treatment plans and obtain prior approval. Clarification should be sought if you are uncertain.
Former Western Australia Police Officers and former Aboriginal Liaison Officers who have suffered a work related injury or disease while in service are entitled to claim for medical and other expenses incurred from 1 July 2007.
Former Officers can claim but must provide sufficient information to verify the claim.
Former Officers who resigned or retired are entitled to claim medical and other expenses.
Subject to the provisions of the Act, Former Officers who were dismissed may be entitled to claim medical and other expenses.
Former Officers are entitled to claim for medical and other expenses incurred from 1 July 2007, regardless of when the injury or disease occurred.
There are no time limits in relation to the injury or disease, however, the injury or disease must be work related and sustained while in service.
The following examples of medical and other expenses, where necessary and
reasonable, can be claimed:
- General Practitioners (GPs),
- Medical Specialists,
- Physiotherapists,
- Chiropractors,
- Ambulance,
- Chemist expenses,
- Psychological,
- Dental,
- Hydrotherapy,
- Occupational Therapists,
- Osteopaths.
Consideration will be given for other types of treatment but will usually require a referral from a GP or specialist.
Former Officers do not have to claim through Medicare or their private health insurance first.
Former Officers are entitled to claim reasonable costs associated with travelling to and from appointments. To do this, the Insurance Commission requires evidence of the travel being claimed to consider reimbursement of these costs. Complete the Reimbursement of Travel Expenses Form and submit it to the Insurance Commission.
From 1 July 2008 the rate payable is 39c per km. This rate is indexed annually (each July).
In circumstances where a Former Officer's injury prevents use of a personal motor vehicle or public transport, please contact the Insurance Commission to discuss alternative arrangements.
Prescribed amounts are the maximum entitlements available to Former Officers for medical and other expenses.
The maximum amounts you can claim for currently, are:
- $50,550.00 (indexed annually).
- Up to a further $50,000 subject to agreement or by applying to WorkCover.
- Up to a further $250,000, in increments of $50,000 by applying to WorkCover and agreement by the Commissioner of Police.
The Western Australia Police, Insurance Commission or WorkCover can advise you on how to apply for the increments.
When a Former Officer disagrees with a claim decision made by the Insurance Commission, access to a two stage dispute resolution process is available.
The two stages of dispute resolution, are:
Stage 1
The Former Officer should contact the Insurance Commission's Claims Officer assigned to the claim. This will provide the Former Officer with access to the Insurance Commission's Internal Dispute Resolution process. Either the Claims Officer will be able to resolve the issue for the Former Officer directly or will refer the matter to a senior Insurance Commission Claims Officer for review and resolution.
The Insurance Commission will respond to any dispute created either at the time of the initial contact with the party concerned, or within 3 working days of the lodgement of the dispute.
If the matter cannot be resolved by the initial informal discussion, and further information (e.g. new medical or factual evidence) that may allow a decision to be reconsidered is subsequently provided, the Insurance Commission will review the further submission within 10 days of receipt and notify the party whether or not the dispute can be resolved.
Stage 2
A Former Officer may refer the matter to the WorkCover WA Dispute Resolution Directorate for determination where:
- the party is not prepared or able to provide additional information for reconsideration;
- the further information submitted has been reviewed; however, subsequent discussion has failed to resolve the dispute.
Where a Former Officer is legally represented, the Insurance Commission will provide the representative with copies of any correspondence that is sent to the Former Officer.
The Insurance Commission recommends that the Former Officer follows this process through the stages, however the Former Officer has the right to move directly to stage 2 if they wish.
The Dispute Resolution Directorate is a division of
WorkCover WA with the responsibility of arbitrating disputes between parties within the workers' compensation system. The Dispute Resolution Directorate will also arbitrate disputes between parties relating to the
Police (Medical and Other Expenses for Former Officers) Act 2008.
If a Former Officer, with an accepted claim, experiences a return of symptoms that requires additional treatment after a period of recovery from the original injury, the Former Officer is required to:
- Report the recurrence immediately to the Western Australia Police.
- Provide a current Medical Certificate from a General Practitioner.
- Complete a Recurrence of Disability Form and submit the form and Medical Certificate to the Western Australia Police.
The Western Australia Police must then submit the completed form and medical certificate to the Insurance Commission, and the Insurance Commission will review the claim and information provided to determine and communicate a decision on liability.
If a claim has been lodged, an Insurance Commission contact will be identified on correspondence. For more information you should contact the named Claims Officer at the Insurance Commission or the Western Australia Police Health and Welfare Services. Alternatively please see our
contact details page.
If you are enquiring about a claim, please have your claim or reference number available.
