Medical Care Scheme
- Medical Care under the Occupational Injuries Scheme
- Expenses covered under the Scheme
- How do I qualify?
- How to apply
- Where to apply
Medical Care under the Occupational Injuries Scheme
You may get benefits under the Occupational Injuries Scheme if:
- You are injured at work, or on an unbroken journey to/from work, or
- You contract a prescribed occupational disease
One of these benefits is Medical Care. The Medical Care Scheme allows you to get a refund of the costs of medical care and treatment not paid by the Health Service Executive (HSE) or covered by the Treatment Benefit Scheme.
The list of prescribed occupational diseases and injury is set out in Schedule 4, Part 1 of S.I. No. 102/2007 - Social Welfare (Consolidated Occupational Injuries) Regulations 2007.
Expenses covered under the Scheme
The following expenses may be refunded if they are not fully met by the HSE or the Department of Social Protection's Treatment Benefit Scheme:
- Doctors' visits
- Doctors' prescriptions
- Certain medical or surgical appliances and the repair and replacement of these (for example, artificial limbs or hearing aids)
- Certain dental and optical treatment
- Certain treatment prescribed by your doctor excluding treatment available under the Health Acts (for example, physiotherapy, scans (MRI) and consultant consultations)
- Certain travelling expenses, usually limited to public transport to and from where the medical care is provided. If you use your own car, your travel expenses may be calculated on a fixed rate per mile. If a taxi is necessary, payment of the full cost may be covered. Expenses for the cost of travel may be paid for travel to both public and private appointments.
The expenses must be reasonable and necessary. Normally, only one payment is made but if the treatment is ongoing, payment may be made in a few instalments. Payment is usually made to the person who claims, but may be made to the HSE, or to your employer if the cost of your treatment is paid by your employer.
How do I qualify?
To qualify for a refund of medical costs, your injury must have been caused by an accident at work, or you must have contracted a prescribed occupational disease as a result of your work
You should notify the Department of your intention to claim medical care within 6 weeks of the start of medical treatment. This is normally 6 weeks from the date of the accident or the development of the disease.
The accident or disease must have happened when you were in employment insurable at PRSI class A, B, D, J or M.
All work accidents or occupational diseases may not result immediately in illness or disablement. If you are not immediately incapacitated but wish to safeguard your future right to benefit, you should tell your employer about the accident/disease. You should apply for a declaration that your accident/disease was an occupational one. This should be done without delay.
How to apply
To apply, complete a Medical Care form C1.
Make sure you quote your PPS number on any receipts you send in with the Medical Care claim form C1. Note that only original receipts are accepted. Payment will not be issued for a claim based on photocopied receipts.
You can get more information on the Medical Care scheme.