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Private health insurance and injury claims

Private health insurance can help pay for treatment that Medicare does not fully cover. If you also have a CTP or WorkCover claim, there are some extra things to know.

Last checked: 30 October 2026
General information only, not legal, financial or medical advice. Check the official website for your situation.

How claims work

Your cover depends on your policy. Hospital cover and extras cover pay for different things. Ask your insurer what your policy covers before treatment.

What is a gap?

A gap is the amount you pay yourself. It is the difference between what the doctor or hospital charges and what Medicare and your insurer pay. Ask for a written quote before treatment.

If you also have a CTP or WorkCover claim

Many insurance policies do not pay for treatment when compensation may pay for it. Your insurer may ask about your claim.

Sometimes an insurer pays first. If you later get compensation, the insurer may ask you to pay that money back.

CTP (car accidents): If the CTP insurer refuses your claim, you may be able to use Medicare or private health insurance in the meantime. These costs may be repaid if the claim is later accepted.

WorkCover: WorkCover Queensland can pay approved treatment costs when a claim is accepted. If the claim is not accepted, you must pay the costs.

If you have a complaint

First, talk to your insurer. If this does not fix the problem, contact the Private Health Insurance Ombudsman. The service is free. Phone 1300 362 072.

Sources

Injured and not sure what to do?

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