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.
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).
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.
- 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!