Medical Care Scheme

If you are injured at work, on an unbroken journey to/from work or you contract a prescribed occupational disease you may get benefits under the Occupational Injuries Scheme. One of these benefits is Medical Care. The Medical Care Scheme allows you to get a refund of the costs of medical care and attention that are not paid by the Health Service Executive (HSE) or covered by the Treatment Benefit 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 the cost of public transport.

The expenses must be reasonable and necessary. Medical Care is paid by Electronic Fund Transfer (EFT). 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.

To qualify for a refund of medical costs you must satisfy the following conditions:

• Your injury must have been caused by an accident at work or as a result of your work you must have contracted a prescribed occupational disease and
• 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 and you must be 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.

To apply, fill in a Medical Care form C1 (pdf). If you don't have a C1 form, you can phone the Medical Care Section and ask them to send you a C1 (see address below). You can get more information on the scheme in the leaflet Medical Care SW34.

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 issue for a claim based on photocopied receipts.