If you have experienced a work-related injury and want to make a claim through WorkCover, it’s important to follow the steps below to ensure your claim is accepted. The claims process is generally straightforward, but there are specific requirements that both the injured worker and their employer need to take.
Timely action is essential, as claims lodged outside of the timeframes may be rejected. It’s important to document your injury, the circumstances in which it occurred, and any medical treatment received. When you see a medical practitioner, whether it’s your GP or at the hospital, let them know that your injury or illness occurred at work.
Step 1: Immediately After the Incident
If you’ve been injured at work, it’s important to act quickly and follow the correct steps to protect your health, rights, and entitlements. The process begins with ensuring your safety and notifying your employer.
Below is a step-by-step guide to help you through each stage of a WorkCover claim.
1.1 Ensure Safety and Seek Medical Attention
- Prioritise Safety: Ensure the area is safe to prevent further harm.
- Seek Medical Care: Visit a doctor or hospital promptly. If you go to a public hospital, they will automatically send your work capacity certificate to WorkCover Queensland.
- Request A Medical Certificate: Ensure you ask your medical practitioner for a medical certificate and a Certificate of Capacity
What is a Certificate of Capacity?
A Certificate of Capacity is a key medical document that outlines your injury, work capacity and treatment plan. It must be completed by your doctor and submitted with your claim. Without this certificate, WorkCover may be unable to process or approve your claim. Keep it updated for ongoing support.
1.2 Notify Your Employer
- Inform Your Employer: Report the injury to your employer as soon as possible.
- Provide Documentation: Submit your work capacity certificate to your employer.
- Employer’s Responsibility: Employers must report the injury to WorkCover within eight business days of becoming aware of the injury.
Step 2: Lodging Your WorkCover Claim
Once you’ve received medical attention and notified your employer, the next step is to lodge your claim with WorkCover Queensland. This ensures your injury is formally recorded and assessed for compensation. To do this, you’ll need to gather some key information and choose the most convenient way to submit your claim.
2.1 Prepare Necessary Information
Gather the following details:
- Personal Information: Full name, date of birth, and contact details.
- Incident Details: Date, time, and description of the injury.
- Medical Documentation: Work capacity certificate from your doctor.
- Supporting Documentation: Any other details that may support your claim.
- Employment Details: Normal weekly earnings and working hours.
- Employer Information: Employer’s name and contact
Tips to avoid your claim being rejected
To help avoid a WorkCover claim being rejected, report the injury promptly, seek medical attention early, and submit all required documentation, especially your Certificate of Capacity. Be honest and detailed when describing how the injury occurred. Delays, missing information or inconsistencies can impact your claim’s success.
2.2 Submit Your Claim
You can lodge your claim through:
- Claim Online: Submit your completed form online via the WorkCover Queensland website.
- Phone: Call 1300 362 128 to speak with a WorkCover representative.
- Fax/Post: Download the claim form, complete it, and fax to 1300 651 387 or mail to GPO Box 2459, Brisbane, Qld 4001
What are provisional payments?
While your claim is being assessed, provisional payments may be made for up to 12 weeks for medical expenses and wages. These allow early support while WorkCover investigates the claim. You don’t have to repay these payments, even if the claim is later rejected, unless fraud is involved.
Step 3: WorkCover’s Assessment Process
After you lodge your claim, WorkCover Queensland will begin assessing your eligibility for compensation. This involves gathering information from you, your employer, and your medical providers to fully understand the nature of your injury. The goal is to make a fair and timely decision based on all relevant details.
3.1 Information Gathering
WorkCover will:
- Contact You: Reach out to discuss your injury and gather necessary information.
- Consult Your Employer: Obtain details about your employment and wages.
- Review Medical Records: Collect information from your healthcare providers.
- Independent Medical Examination (IME): In some cases, you may be required to attend an IME to assess your injury or illness and potential treatment expenses.
3.2 Decision Timeline
- Standard Processing Time: WorkCover aims to make a decision within 20 business days.
- Delays: Delays may occur if additional information is needed.
What can be covered in a WorkCover claim?
WorkCover can cover a range of expenses, including weekly compensation, medical and rehabilitation costs, travel for treatment, and sometimes lump sum payments for permanent impairment. They may also assist with return-to-work programs. All treatments must be approved and related directly to the workplace injury to be eligible.
Step 4: Understanding Compensation and Support
Once your claim is accepted, WorkCover Queensland may provide financial support and cover treatment costs while you recover. This includes weekly compensation if you’re unable to work, payment for medical and rehab expenses and potentially a lump sum if you have a permanent impairment.
Understanding what you’re entitled to can help you make informed decisions during your recovery.
4.1 Weekly Compensation
- Eligibility: If your injury prevents you from working, you may be entitled to weekly compensation.
- Payment Method: Payments are made either through your employer or directly to you.
- Calculation: Typically, compensation is 85% of your normal weekly earnings. WorkSafe.qld.gov.au
4.2 Medical and Rehabilitation Costs
- Coverage: WorkCover may cover reasonable medical and rehabilitation expenses related to your injury.
4.3 Lump Sum Payments
- Permanent Impairment: If you have a permanent impairment, you may be eligible for a lump sum payment.
- Assessment: An independent medical professional will assess your impairment to determine the compensation amount.
How long can coverage last after a claim is made?
WorkCover support can continue for up to five years in Queensland, depending on your condition, recovery, and work status. Coverage may include weekly payments, treatment and rehabilitation support. If you have a permanent impairment, you may also be eligible for a lump sum or further entitlements under common law.
Step 5: If Your Claim Is Rejected or Ceases
If your WorkCover claim is rejected or payments stop, it’s essential to understand why and what you can do next. You may have the right to request a review or lodge an appeal. Acting quickly, staying organised and seeking support from WorkCover lawyers can help you navigate the process and protect your entitlements.
5.1 Understanding the Decision
- Reasons for Rejection: Claims may be rejected if they don’t meet specific criteria, such as being lodged within the correct timeframe or not being work-related.
5.2 Options After Rejection
- Review: You can request a review of the decision by the Workers’ Compensation Regulator.
- Appeal: If you disagree with the review outcome, you may appeal to the Queensland Industrial Relations Commission
- Timeliness: Report the injury and lodge your claim as soon as possible to avoid delays.
- Documentation: Keep copies of all medical and employment records related to your injury.
- Communication: Maintain regular contact with WorkCover and your employer throughout the process.
- Common Law Claims: In some cases, you may be able to make a common law claim depending on the nature of your work injury.
Need Help To Make A WorkCover Claim?
If you need help, contact our WorkCover lawyers, who can assist you with all stages of your matter.
