Workcover: most frequently asked questions
I was injured at work – what should I do?
- Immediately notify your employer of your injury. It is very important to report your injury as soon as possible, within 30 days to avoid complications in your claim.
- Obtain medical treatment for your condition.
- If you are unfit for work, request a WorkCover certificate from your doctor.
- Give your medical certificate and a completed claim form to your employer who should sign and return the workers copy to you, (Remember to complete the details on the rear of your medical certificate). Claim forms can be obtained from the WorkCover Authority, or Post Office.
- Your employer is required to forward the claim to the WorkCover authority within 10 days. The WorkCover claims agent must make a decision to accept or reject your claim within 28 days of the receipt of the claim by your employer. If your employer refuses to accept a claim, it can be lodged on the WorkCover Authority direct at 222 Exhibition Street Melbourne.
- Also see our post on how to fill in your injury claim form
What must I prove in a claim for damages?
Claiming damages can be a very complicated process. Under WorkCover, there are three elements that you must establish to obtain common law damages.
- That you are suffering from a “serious injury.“
- You have suffered loss and damage as a result of your injury.
- Some other person was negligent.
Can I claim economic loss damages in a common law claim?
- If you are certified as having a serious injury under the ‘quantitative test’ (i.e. an impairment rating of 30% or more), OR
- If you can show that your earning capacity has been permanently reduced by at least 40 %. This involves will be a very complex assessment of the claimant’s earnings and earning capacity 3 years before injury and a claimant’s earning capacity (not just actual earnings) 3 years after injury.
Read more about common law damages claims here.
Can I claim for work causing death?
If a person dies as a result of a work injury or a medical condition caused or worsened by work, it is possible to make a claim. People entitled are:
- A spouse (even if they also work).
- Dependent children including full time students up to age 21.
- A partner of the deceased worker.
- Anyone else who was wholly or partly dependent
What Compensation is covered and paid for?
- Any disease caused by work.
- Any disease or pre-existing condition made worse by work.
- Injuries suffered whilst travelling as part of work.
- Injuries suffered whilst having medical treatment for a separate work injury.
Does my employer have to continue to contribute to my superannuation fund whilst I am off work?
There is no obligation on your employer to contribute to your superannuation fund whilst you are absent from work on WorkCover.
Does my weekly payment include my employer’s contribution to my superannuation fund?
Unfortunately, your WorkCover weekly payment will not include your 9% superannuation guarantee levy contribution which is made on your behalf by your employer. If you were injured in 2010 Workcover contributes to super.
Does my employer have to hold my job open?
The WorkCover legislation requires your employer to provide you with suitable employment (if you remain partially incapacitated) or equivalent employment (if you have recovered) – in Vic -within the first 12 months of your absence from work.
Can my employment be terminated while on WorkCover?
There is no specific law that prevents an employer sacking you whilst you are on WorkCover. However your employer has a duty of care to provide you with employment or alternative employment during the first 12 months following your injury (Vic). It is however an offence for an employer to sack you solely because you have made a claim.
For time frames in other states, click here
How many times a year can I be sent for a review (IME) by the Insurance Agent?
Once every two years they can send you to one or more of their practitioners Psychologist/Psychiatrist/ Surgeon/Physiotherapist/ Vocational Assessors other. If you feel they are sending you excessively to see too many doctors, you should forward in writing a letter of complaint to the insurer and to Workcover.
Also read our useful article on how to prepare and protect yourself for an independent medical examination
Can I have someone with me as support during my appointments?
Yes you can.
Can a medical review personal from Workcover do a review by phone with one my medical practitioners?
We suggest you advise your medical treaters and your insurance Agent that you do not give consent to verbal reviews by phone, but you must and will consent to be sent to see one of their practitioners for a written report.
An Examiner retained by the WorkCover Authority is required to conduct their examinations on a proper professional basis. If you believe that the Examiner has failed to meet the standard you can report the matter to the WorkCover Authority. If the examination involved serious unprofessional conduct, the matter could also be reported to the Medical Board of Victoria.
Can the Insurer stop paying for medical and like expenses, if they get a report from one of their practitioners that they have sent you to see?
Resolution of a dispute by a court should be a last resort seek legal advice.
What medical and like services am I entitled too?
Refer to our post:medical and like services, know your entitlements
Will WorkCover try to film me?
The WorkCover Authority considers that surveillance of a claimant is a legitimate tool for management of a claim. The use of surveillance can occur at any time during a claim and is not limited just to long term claims or court cases. Some, information from surveillance can cause considerable damage to a WorkCover claim. They will check on facebook and online communities for any information on you.If you have information that your surveillance has breached a law such as trespass, photographing children without permission etc then you can report that conduct to direct to The Assessment Centre on 03 9641 1051 or contact the WorkCover Authority( VIC).
Read more about video surveillance tactics used here
Can the insurance agent give surveillance that you are not aware of to their practitioners that are assessing you?
Yes, without you even being aware that you where under surveillance.
Can surveillance influence the practitioners that the insurer sends me to see?
Yes, most definitely.
Can I request surveillance tapes and reports?
Yes, Fill the Freedom Of Information Form, make a copy and send it to the Insurer.
How long does it take for WorkCover to make a decision whether or not to approve a treatment or test (i.e. MRI, surgery, physiotherapy,home help etc)?
Unfortunately the law doesn’t say anything about time frames. However the WorkCover Authority states that a decision should be made within 60 days, which can be a very long time, especially if your treatment is urgent. If you have not heard back from the insurers after 28 days, you are entitled to inquire about the decision. Make notes about who you spoke with, the dates, the names and positions of those you have spoken with. It also may help if your treating specialist writes in his/her referral that your requested test or treatment is URGENT.
WorkCover has terminated my medical treatment, what should I do?
The most common reasons for a rejection or termination of medical expenses are as follows:
- WorkCover medical advisers have indicated to WorkCover that the treatment is unnecessary.
- WorkCover considers the treatment is no longer effective or can be replaced by self managed home exercises.
- Weekly payments have ceased more than 52 weeks.
If WorkCover advise you that they intend to terminate your medical treatment expenses, you should refer the dispute to the Accident Compensation Conciliation Service for resolution of the dispute.
If I do not agree with decisions made by my Insurance Agent, how are disputes with WorkCover resolved?
Resolution mechanisms are available; with the proper guidance most disputes with WorkCover should be resolved without a court hearing. Most disputes are initially referred to the Accident Compensation Conciliation Service, which will attempt to resolve a dispute in an informal manner. It is necessary to lodge an application for conciliation. You have 21 days to lodge a dispute form and ask for Conciliation.
Resolution of a dispute by a court should be a last resort as there are a number of alternative dispute. How many reports can I obtain from my doctors for conciliation?
As many as you see reasonable, to address your case.
Should I seek for my dispute to go to a Medical Panel?
This is a complex issue. A decision of the Medical Panel is usually binding on the parties and a court is generally required to follow its decision.
Can I appeal the decision of a Medical Panel?
The decision of the Medical Panel can only be appealed on very narrow grounds. It is only possible to appeal the decision if the Panel has made legal error. It is not possible to appeal the decision of a Panel solely on the basis that it came to the wrong conclusion.
Does the insurer send all of my medical reports from my doctors to the practitioners they send me to see?
Most likely not. They will choose which reports or how many they send. MAKE COPIES AND BRING ALL OF YOUR OWN REPORTS WITH YOU TO APPOINTMENTS…
Can I ask the Insurer for my file or the doctor’s reports?
Yes , fill in the Freedom Of Information Form , make a copy and sent it to the insurer..
Can I attend emergency at a private hospital if I am in acute pain from my injury?
Yes. The insurer will reimburse you the payment.
Does your GP have to send all of your medical history to the Insurance Agent when requested?
No, only material relevant to your current injury.
If my claims agent is unreasonable or always loses receipts for payments or does not comply with the act, can I request a change of person?
Yes , put your complaint in writing to the insurer and to Workcover and ask for a response.
Can the Insurers or their Legal Representative request my Passport?
Insurance Agents cannot request your passport but their Legal Representatives can for Court Proceedings only.
Can the insurer or their Legal Representatives obtain your financial records?
Insurance Agents cannot obtain your financial records but their legal representatives can for Court Proceedings only.
Legal Fees:
- Some legal Firms Offer a NO WIN – NO CHARGE fee arrangement.
- Some have fees based on the Practitioners Remuneration Order, the official scale that should be used for non litigated matters.
- Some firms do NOT use an “in house” scale, this usually greatly inflates charges.
- Some Firms Negotiate Fees.
- Ensure that legal fees do not erode your impairment payment.
- Looking for a good lawyer? Check out Shine Lawyers
5 Steps For Surviving WorkCover
- Make the most of your recovery.
- Understand your WorkCover entitlements.
- Assess your future work capacity.
- Retrain if necessary.
- Obtain legal advice sooner rather than later.
- Also see survival guide for injured workers
- Also see surviving workcover some more tips
Do you have a problem with your workcover claim?
Simply post it here and we and/or our many readers may be able to help you!
Don’t forget to check out our blog posts and articles (i.e. blog archives page and search box) and to check out our tips and tricks for more useful information on all things workcover!
To whom it may concern.
My husband injured his back earlier this year while at work and had two weeks off initially and then he has had about 6-8 days off as a continuation of this injury,
We just found out that his work never lodged his injury through work cover because they did not wish to pay the excess and because of that now he is being not paid for any further sick days. And subsequently we have lost money right before Christmas (the most recent time off he had was due to his back injury again)
Can someone please advise us of our rights here.
Hi L
I might be able to offer a few suggestions, but I have noticed that many of the regular contributors are busy away from the site, which I hope is a good thing for them, rather than due to crippling pain that often keeps most of us away at times. There are lots of pages of suggestions & resources on this blog that may help. It is illegal to not lodge the WC claim with the insurer. But many Employers break this law & dont ever get punished for it. You need to ring the Workcover body for your state. http://aworkcovervictimsdiary.com/resources/workcover-resources-state/workcover-vic/ this is the link for Victoria, so if your state is different, there are pages with the correct contact details for your state on the resources pages as listed at the top of this site.
You should contact the Workcover body & give them all the details & they should be able to get the ball rolling for you. Horrible time of year for this to happen, but when it comes to work injuries & Workcover there is never ever a good time of year. Try to find some time to read some of the stories & you will find that most of them are horror stories that have dragged on for many many years & affected many Christmases. Best thing you can do is get to know what WC is all about & what your (or your loved one’s) rights are. Then hope & pray that the injury is a quick recovery because WC is never easy to be involved with.
Is there any situation where the employer is exempt from paying the work cover levy?
I DON’T UNDERSTAND HOW W/C WORK? MY PARTNER HAS A MAJOR SHOULDER INJURY FROM WORK, THE DOCTOR WON’T GIVE HIM A SLIP TO SAY HIS FIT TO RETURN TO WORK BUT CGU CAN CUT HIS W/C PAYMENTS OFF. NOW HIS GONE FROM BEING A SHIFT WORKER ON AWESOME MONEY WHO HAD A WORK PLACE ACCIDENT, TO HAVING TO GO ON SICKNESS BENEFITS!!
SO WERE IS THE JUSTICE IN THIS??
@Kylie – not sure in which state your partner resides – the laws do vary from state to state. However to give you an idea, in VICTORIA:
For the first 13 weeks, if you can’t work, you are entitled to 95% of your pre-injury average weekly earnings (subject to a maximum). Please contact our office for advice on 9321 9988 to find out how this is calculated.
After 13 weeks and up to 130 weeks, payments continue at 80% if you have no capacity for work.
If you are able to do some work, you are entitled to 80% of the difference between what you are earning and your pre-injury average weekly earnings.
Some workers can have their weekly payments continue where they have no current capacity for work and that situation is likely to continue indefinitely.
If you are working at least 15 hours per week and are likely to continue indefinitely to be incapable of undertaking further or additional employment or work, you may be entitled to further compensation beyond 130 weeks.
A similar set-up applies in all states – in other words your weekly pay gets cut off after a certain period of time, even if you can’t work – because for weekly pay to continue you must be deemed unable to work for the foreseeable future (forever basically). This applies to what they call seriously injured workers who have severe permanent injuries and are found by a court or medical panel or many IMEs not to have a work capacity for ever.
The workcover system is the most unfair of all systems, it denies legitimate and basic “compensation” (as in living expenses, basic survical) to MOST injured workers, after a set period of time. They could not care less whether you can’t work, as long as you have some capacity even if it’s in the future, you get cut off. Meanwhile, as we’ve said many times, injured workers live of Centrelink (public purse).
I am a casual / sessional worker and October last year injured my back whilst lifting, did not have any time of work just some restricted duties,got a bit of treatment thinking that my employer had put a claim in for me, this had not happened, losing shifts because of light duties so asked the my GP to lift my restrictions. My Back has not got any better, in fact a lot worse, GP sent me to a specialist and it turns out I need surgery, the WC claim was put through Jan / Feb and accepted in April to pay for medical expenses, so thats great, my problem is that, as soon as my employer found out about me needing surgery, my shifts stopped, I probably shouldn’t have lifted my work restrictions as now my back is really bad, what do I do, I have no money coming in at all, have booked an appt with my GP to assess my work fitness again but dont know what to do
@Matt – your health should always be a priority – easier said than done when it’s about losing income, but remember that workover must/will pay you weekly payments if you are unable to work or are only able to work partially. Not sure in which state you are located but for weekly payments in VIC check out our FAQ worksafe section.
Most states have a similar weekly payment system.
For example when you have surgery and can’t work you will be paid you average weekly income for the period you can’t work.
It sounds as you may be better off going off work all together until you have had your surgery – talk to your GP. If you can’t work because of your back pain you will get weekly payments from workcover.