Question 1

Does WorkCover cover orthopaedic surgery?

Accepted Answer

Yes. If surgery is reasonably necessary for your work injury and the insurer approves it, the cost is covered under your claim — the surgeon, the hospital stay and the anaesthetist. Everything is billed directly to the insurer at the regulated WorkCover rates, so there is no gap fee for approved treatment.

Question 2

Do I need a referral to see the surgeon?

Accepted Answer

Yes — like any specialist, an orthopaedic surgeon works on referral from your treating doctor, and we can book you in with a WorkCover doctor who can write it. If you already have a treating doctor, that’s fine too: ask them for a referral and we’ll take it from there. A specialist consultation on your doctor’s referral within the first three months of your injury doesn’t need insurer pre-approval.

Question 3

Can I choose my own surgeon?

Accepted Answer

You and your doctor choose who you see. In NSW you have the right to nominate your own treating doctor, and your doctor refers you to the specialist you’re both comfortable with. If surgery has been recommended somewhere else and you want another view, the insurer can fund a second opinion — we can help you get one.

Question 4

Will I have to pay anything?

Accepted Answer

Not for approved treatment. The surgeon bills the insurer directly at the regulated WorkCover rates — no gap fee, no upfront cost. If something hasn’t been approved yet, you’ll hear from us before anything is booked. Our help is free, so you’ll never get a bill from us.

Question 5

Does surgery need insurer approval first?

Accepted Answer

Usually, yes. Non-emergency surgery needs prior approval, and it’s your surgeon who submits the request — with the scans, clinical notes and reasons the insurer needs to say yes. The insurer then has 21 days to decide, and urgent requests are prioritised. We keep you updated the whole way, and surgery isn’t booked until approval is in place — that’s what keeps you at zero out of pocket.

Question 6

What if the insurer knocks the surgery back?

Accepted Answer

It happens, and it’s not the end of the road. The insurer has to give written reasons, your surgeon can provide further evidence and ask for a review, and you can get free advice from the Independent Review Office. The insurer may also ask for an independent medical examination — though the scheme rules expect them to offer you a second opinion first, and they can’t send you to an IME about proposed surgery until they’ve put their questions to your treating surgeon. If it’s still declined, we put you in touch with a compensation lawyer. Most WorkCover disputes qualify for IRO funding, which usually means the legal costs aren’t yours. You won’t be left to work it out alone.

Question 7

Who follows up the insurer approval — me or you?

Accepted Answer

We do. Your surgeon submits the approval request with the scans, notes and item numbers the insurer needs, and our team handles the paperwork and follows it up. You don’t ring the case manager, you don’t follow up an approval number, and you don’t carry forms between appointments — that’s our job, and it’s half the reason to call us.

Question 8

I was hurt in the last 48 hours — do I need approval before getting treated?

Accepted Answer

No. Treatment within 48 hours of a work injury is exempt from insurer pre-approval, and public hospital emergency care never needs it — so if it’s an emergency, go straight to the emergency department. From there, we book you in with a WorkCover doctor for your certificate of capacity, help get the claim lodged, and arrange a specialist opinion if the injury needs one.

Question 9

My injury aggravated something I already had — is surgery still covered?

Accepted Answer

Often, yes. The NSW scheme covers an aggravation of a pre-existing condition where your work was a contributing factor — an old knee problem that a work injury made worse is a common example. The insurer looks at what your work actually contributed, which is what your doctor and surgeon set out in their reports. Don’t rule yourself out before a proper assessment.

Question 10

Do I have to have surgery?

Accepted Answer

No. Plenty of injuries that look surgical early on recover well with physio and time. The surgeon gives you an honest opinion — if surgery isn’t going to help you, they’ll say so. And even an approved surgery is always your call; getting a specialist opinion commits you to nothing.

Question 11

How long until I can work again after surgery?

Accepted Answer

It depends on the procedure and your job. A carpal tunnel release might mean a few weeks on modified duties; a shoulder reconstruction can take months of rehab. Your surgeon, doctor and physio plan a graduated return together, your certificate of capacity is updated at every stage, and your weekly payments continue while you’re certified unfit.

Question 12

Another surgeon already told me I need surgery. Can I get a second opinion?

Accepted Answer

Yes. We can arrange a second opinion from an orthopaedic surgeon who takes WorkCover cases. Bring your scans and reports — or we’ll request them — and you’ll get an independent view on whether the recommended surgery is the right move. The insurer can fund the consultation as part of your claim.

Question 13

What about follow-up surgery later — like getting plates removed?

Accepted Answer

The scheme has a specific rule for this. If a further operation is a direct consequence of your earlier approved surgery on the same part of the body, and it’s approved within two years of the earlier approval, it’s covered — the operation, the hospital, the post-op treatment and your weekly payments while you recover — even if your normal medical entitlement window has closed. We keep an eye on those timeframes for you.

Tools

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Workers Compensation

Orthopaedic Surgeons for Work Injuries — Specialist Care, Covered.

When Rest and Physio Aren't Enough

How We Help You Get a Surgical Opinion

Injuries and Body Areas Covered

From First Appointment to Back at Work

See a WorkCover doctor

Imaging and conservative care

Specialist orthopaedic opinion

Surgery, if it's the right call

Post-op rehab with a physio

Back to work

Your Doctor, Physio and Surgeon — In Step

What That Means for You

WorkCover Orthopaedic Surgeon FAQs

WorkCover Orthopaedic Surgeons Across Sydney

Get a Specialist Opinion