Filing a WorkCover Claim in QLD: The Step-by-Step Guide

Best Injury Lawyers Insights  |  January 29, 2024
road workers on the side of road with traffic cones

Navigating the world of workplace injuries and compensation can be challenging, especially when you’re dealing with the complexities of the WorkCover system in Queensland (QLD), Australia. WorkCover QLD is a vital government-initiated program designed to provide financial and medical support to employees who suffer from work-related injuries or illnesses. Understanding how this system functions and the steps involved in filing a claim is crucial for any Queensland worker.

This guide aims to demystify the WorkCover claim process in QLD. Whether you’re a full-time employee, a part-time worker, or a contractor, it’s essential to know your rights and the procedures to follow if you ever need to make a WorkCover claim. The process might seem daunting at first, but with the right information and guidance, you can navigate it with confidence. Our step-by-step guide will provide you with a clear roadmap, ensuring that you’re well-informed and prepared to take the necessary actions should the need arise.

What is WorkCover?

WorkCover in Queensland is a key part of keeping workers safe. It’s a program set up by the government to help employees who get hurt or sick because of their job. Employers in Queensland use WorkCover to make sure their workers get financial support and medical care if something goes wrong at work.

This program covers many types of work-related injuries and health issues. If you get hurt while doing your job, whether you’re in the office or somewhere else for work, WorkCover can help. It’s not just for accidents that happen suddenly. It also helps with health problems that take time to show up because of your work, like stress or injuries from doing the same thing over and over.

WorkCover also looks after workers who get hurt or sick during work trips, breaks, or while at work-related events or training. The goal is to make sure that no worker has to deal with money problems or health issues alone because of something that happened at work.

It’s important for every worker in Queensland to know what WorkCover does. This knowledge helps you make smart choices and take the right steps if you ever need to file a claim with WorkCover.

What are the eligibility criteria for filing a WorkCover Claim in QLD?

Wondering if you can file a WorkCover claim in Queensland? It’s pretty simple to figure out who’s eligible. Basically, if you’re a worker in QLD and you get hurt or sick because of your job, you’re likely covered.

Here’s a breakdown of who can make a WorkCover claim:

  • Full-time and Part-time Employees: If you work regular hours, either full-time or part-time, and get an injury at work, you’re eligible.
  • Casual Workers: Even if you work on a casual basis, you’re still covered. WorkCover doesn’t leave out casual workers when it comes to claims.
  • Contractors and Subcontractors: Sometimes, even contractors or subcontractors can be eligible for a claim, depending on how closely their work is connected to the business they’re working for.
white van driving down mountain road at dusk

Can apprentices and trainees file a WorkCover Claim?

Yes! As an apprentice or trainee, if you’re injured while learning on the job, you can file a WorkCover Claim.

It’s not just about the type of work or your employment status. The main thing is that your injury or illness should be related to your job. This could be an accident at your workplace, an injury while working offsite, or a health issue caused by your work activities.

Remember, each case is different. So, if you’re unsure whether you can file a claim, it’s a good idea to get more information or talk to someone who knows about WorkCover claims in QLD.

By keeping these points in mind, you can have a clearer understanding of whether you’re eligible to file a WorkCover claim in Queensland. This knowledge is key to making sure you get the support you need if you ever get hurt or sick because of your work.

Understanding Your Rights and Obligations

When it comes to WorkCover in Queensland, it’s important to know what you’re entitled to and what you need to do. Let’s break down your rights and responsibilities in simple terms.

Your Rights Under WorkCover:

  • Medical Care: You have the right to get medical treatment if you’re injured because of your job. You also have the right to received treatment from your own medical providers, and you are not required to see doctors suggested by your employer.
  • Compensation for Lost Wages: If you can’t work because of your injury, you’re entitled to get paid a part of your usual wages.
  • Privacy: Your personal information and details about your claim are kept private.
  • Fair Treatment: You have the right to be treated fairly and without discrimination during the claim process.

Your Obligations When Making a Claim:

  • Report Your Injury: You need to tell your employer about your injury as soon as possible.
  • See a Doctor: Get medical help and have the doctor fill out a WorkCover QLD Work Capacity Certificate. This certificate is essential for your claim and you will need to ensure you always have a current Work Capacity Certificate for all of the time you are off work
  • Contact WorkCover to make a claim: You have to complete a WorkCover claim form with accurate information. You can do this by logging onto the WorkCover website and completing a form, or calling WorkCover on 1300 362 128. You do not need your employer’s authority to contact WorkCover. Provide Evidence: If needed, you might have to give more information or evidence about your injury and how it happened.
  • Follow Medical Advice: It’s important to follow the treatment plan your doctor recommends.
  • Keep in Touch: Stay in contact with your employer and WorkCover about your recovery and return to work.

Remember, these rights and obligations are there to protect you and make sure you get the help you need. By understanding and fulfilling your role in the process, you can ensure a smoother experience with your WorkCover claim in Queensland.

A Step-by-Step Guide to Filing a WorkCover Claim

Filing a WorkCover claim in Queensland can seem like a big task, but breaking it down into steps makes it much more manageable. Here’s a detailed, easy-to-follow guide:

Step 1: Seek Medical Attention and Report the Injury

1. Get Medical Help

Act quickly, and don’t wait to see if your injury gets better on its own. Go to a doctor or a hospital as soon as you can after the injury occurs. You can visit your regular GP, an emergency department, or a medical centre, depending on the severity of your injury. In case of serious injuries, you should seek emergency medical care immediately.

2. Tell the Doctor It’s Work-Related:

Describe how the injury happened at your workplace, being specific about the time, place, and activity you were doing. If you had any symptoms before the incident at work, tell your doctor about them too.

This helps link the injury to your work, which is crucial for your WorkCover claim.

3. Doctor’s Report / Work Capacity Certificate:

Your doctor’s report should detail your injury, the possible cause, the treatment given, and any work restrictions needed. In Queensland, you should ask your doctor to provide a ‘Work Capacity Certificate’ which outlines what you can and can’t do at work because of your injury. Make sure to get a copy of the medical report or certificate for your records. You will need to provide a copy of the certificate to WorkCover.

4. Additional Tips:

If you need follow-up appointments or treatments, make sure to attend them. This shows you’re committed to your recovery. Additionally, keep a personal record of your symptoms and how they affect your daily life. This can be useful if your claim is questioned.

The Work Capacity Certificate will have an expiry date. It is important that you go and get an updated certificate about your capacity to provide to WorkCover, before it expires – to ensure you always have a current certificate. If you don’t have a current Work Capacity Certificate, WorkCover will likely stop paying you.

Step 2: Notify Your Employer

1. Inform Your Boss:

Ideally, inform your employer about the injury on the same day it occurs. If that’s not possible, do it as soon as you can. You can notify them verbally initially, but it’s essential to follow up with written notification. If your injury is severe, ensure someone at your workplace knows immediately, even if you need to go straight to the hospital.

If you’re unsure who to talk to, start with your direct supervisor or manager. If they are unavailable, contact your HR department.

Ask your employer to prepare an incident report and ask for a copy of the incident report. Make sure the information recorded in the report is accurate.

2. Provide Details:

Describe exactly what happened, including the date and time of the injury, where it occurred, and how the incident unfolded. If anyone saw the incident, mention their names. Witness accounts can be crucial in supporting your claim. Clearly state the nature of your injury and how it impacts your ability to work.

3. Keep Records of Everything:

It’s also important to keep a record of these notifications in writing. Send an email or letter to officially document your notification. Include all the details you shared verbally. Keep a copy of this written notice for your records and save any email acknowledgments or replies you receive from your employer. Note down when you notified your employer and when you provided the written notice. These dates could be important later on.

If you don’t hear back from your employer or their response is delayed, follow up. It’s important that they acknowledge your notification. Remember, discussions about your injury should be confidential and handled sensitively.

If you can take photos of the area where you were injured, do so, as it could be important to prove your case.

construction manager going over plans with a pencil at a desk

Step 3: Make the WorkCover claim

1. Time limits

There are strict time limits to make a WorkCover claim in Queensland. It is best to make the claim as soon as possible, so that WorkCover has the opportunity to investigate the claim while the circumstances are fresh in everyone’s memory.

If you make the claim within 20 business days, and it is approved, you will be back paid until the date of the incident.

There is a strict 6 month time limit to make a statutory WorkCover claim. This runs from the date of the incident, or the date your doctor first linked your injury to your workplace. If you miss this date, you could lose your right to claim so do not delay.

Please note, a different time limit applies for common law claims (which is generally 3 years from the date of the incident). Different time limits can apply depending on the nature of your injury and its cause.

2. Get the Form:

The WorkCover claim form is located on WorkCover’s website. When you are on the main site, click “Make a claim” and then there will be a link to the online form. You can also contact WorkCover on 1300 362 128 and make the claim over the phone.

If you’re having trouble finding the form, don’t hesitate to ask your employer, doctor, or contact WorkCover Queensland directly for assistance.

3. Fill It Out Carefully:

Before you start, read all instructions on the form carefully. This will help you understand what information is required.

Fill in every part of the form. If a section doesn’t apply to you, write ‘N/A’ (not applicable) instead of leaving it blank.

Make sure all the details about your injury, employment, and personal information are correct. Inaccuracies can delay the processing of your claim. When describing your injury, be as specific as possible. Mention dates, times, and how the injury occurred.

The same applies if you are calling WorkCover. They will take a detailed file note of your call, and you should too, and they may even record the call.

4. Submit the Form:

You can submit the form directly to WorkCover Queensland on their website.

Before submitting, make a copy of the completed form for your records. This is important in case there are any issues or delays. If you submit the form in person, ask for a receipt or confirmation. If you’re mailing it, consider using registered post or a method that provides tracking and receipt confirmation.

5. Additional Tips:

If you’re not sure how to fill out the form or what information is needed, ask for help. Your employer, doctor, or a WorkCover representative can provide assistance. Take your time to fill out the form – rushing can lead to mistakes or missing information.

Once the form is complete, submit it as soon as possible. Delaying can affect the timeliness of your claim processing.

Completing the WorkCover claim form with care and attention is a critical step in the process. By ensuring that all information is accurate and the form is submitted correctly, you’re laying a strong foundation for your claim and helping to avoid any unnecessary complications.

Step 4: Provide Necessary Documentation and Evidence

1. Medical Reports:

The medical report (Work Capacity Certificate) from your doctor is a key piece of evidence for your claim. Make sure it’s detailed and includes the diagnosis and treatment plan. If you’re receiving ongoing treatment, keep a record of all appointments, treatments, and any referrals to specialists. If your medical condition changes or if there are new findings, get updated reports from your doctor to submit.

2. Other Evidence:

Other evidence you can submit includes:

  • Witness statements
  • Photographs
  • Work incident reports
  • Communication records

If colleagues or others witnessed your injury, their statements can be valuable. Ask them to write down what they saw and remember, including dates and times.

Pictures of your injury and, if applicable, the place where the injury occurred can be helpful. Ensure these photos are clear and dated.

If an incident report was filed at your workplace, include a copy with your claim.

Finally, keep copies of any emails or written communication related to your injury or the incident in case you need to submit them at some point in your claims process. Only submit evidence that is directly related to your injury and claim.

3. Organising Your Documentation:

Organise all your documents and evidence in one place. This makes it easier to find and refer to them when needed. Arrange the documents in the order they were created or received. This helps to present a clear timeline of events and treatment.

Always submit copies and keep the original documents for your own records.

If you’re unsure about what documentation is needed, don’t hesitate to ask for advice from a WorkCover representative or a legal professional.

Step 5: Follow Up on Your Claim Submission

1. Keep Track:

Mark down the date you submitted your claim. This helps you keep track of the process and timeframes. Contact WorkCover or your employer periodically to check the status of your claim.

Don’t assume everything is progressing without your input. Keep a log of all your interactions, including dates and summaries of conversations or email exchanges regarding your claim.

2. Ask Questions:

If there’s anything about the process you don’t understand, ask. It’s better to get clarity than to make assumptions. Inquire about what you should expect next in the process. Knowing what’s coming can help you prepare and reduce anxiety.

If you receive vague answers, ask for more specific information. It’s your right to understand where your claim stands.

3. Get Proactively Involved:

Don’t wait for WorkCover or your employer to reach out. Take the initiative to make contact and get updates.

If WorkCover or your employer contacts you for more information or documentation, respond as quickly as possible to avoid delays in your claim.

Also, be sure to have your claim number and any relevant documents handy when you make inquiries.

The claims process can take time, so patience is important. However, regular follow-ups are key to ensuring your claim doesn’t get overlooked. Keep a file of all correspondence and notes related to your claim. This can be important if there are disputes or delays.

Step 6: Understanding Claim Assessment and Decision

1. Assessment Process:

Once your claim is submitted, WorkCover begins the assessment process. They will review all the information and documentation provided. During this phase, WorkCover might reach out to you, your employer, or your medical provider for additional information or clarification.

While there’s a general 20 business day timeframe for assessments, complex cases might take longer. It’s reasonable to ask WorkCover for an estimated timeline.

2. Decision Time:

You will be informed when WorkCover makes a decision on your claim. This notification usually comes in writing, either through mail or email.

The decision will include details about whether your claim has been accepted or denied, and the reasons for this decision. If your claim is accepted, you’ll receive information about the benefits you’re entitled to, such as medical expenses coverage and wage compensation.

3. Know Your Rights:

If you disagree with the decision made on your claim, you have the right to request a review. This must be done within 3 months of being notified of WorkCover’s decision, so be aware of the deadlines or you will lose your right for a review.

The notification of the decision will typically include instructions on how to request a review. Follow these instructions carefully.

If you’re considering a review, it may be beneficial to seek advice from a legal professional who specialises in workers’ compensation.

It’s a good idea to prepare for both acceptance and denial of your claim. This can include thinking about next steps in either scenario. Keep maintaining detailed records during this phase, including any new correspondence or documentation related to your claim.

What happens after filing a WorkCover Claim?

After you file a WorkCover claim in Queensland, understanding the next steps can help you navigate the process more effectively. Here’s what typically happens:

The Claim Assessment Process

First, WorkCover examines your claim, including the injury details, medical reports, and any other evidence provided. Sometimes, WorkCover may need to investigate further. This could involve talking to your employer, co-workers, or medical professionals to understand the circumstances of your injury.

The length of this process can vary. While some claims are processed quickly, others that are more complex might take longer.

What happens if my WorkCover Claim is approved?

If your claim is approved, you’ll receive a notice explaining the benefits you’re eligible for. This typically includes coverage for medical expenses and a portion of your wages if you’re unable to work. Wages are generally paid at 85% average weekly earnings for the first 6 months, and then it will taper down from there to 70%.

The specific benefits can vary depending on the severity of your injury and your employment circumstances. These might include medical treatment costs, rehabilitation expenses, travel costs for medical appointments, and compensation for lost earnings.

Payments are usually made directly to you for lost wages or reimbursement of medical expenses. Otherwise, WorkCover may pay the hospital or service providers directly.

Recovery and Return to Work

WorkCover will also consider your recovery progress and any ongoing treatment requirements. The goal is to support your return to work, whether it’s in your previous role or in modified or alternative duties.

Your case might be reviewed periodically to assess your recovery progress and ongoing needs.

If you return to work on a graduated return to work plan, your payments from WorkCover will be reduced proportionately in line with how much you are working. If you return back to full work, your payments will stop/

What happens if my WorkCover Claim is denied?

If the claim is disputed or denied, you have the right to challenge the decision. WorkCover provides information on how to request a review or appeal. It may be beneficial to seek legal advice or assistance from a workers’ compensation lawyer in this situation.

workers hand wrapped in bandage after work injury

Should you seek legal assistance for a WorkCover Claim?

Navigating a WorkCover claim can sometimes be straightforward, but there are situations where seeking legal advice can be invaluable. Understanding when and why to consider this step, and how a lawyer can assist, means your rights are protected throughout the claim process.

When and Why to Consider Legal Advice

For complicated cases, such as those involving pre-existing conditions or disputed facts about the injury, a lawyer can provide clarity and direction.

If your claim is denied, a lawyer can help you understand the reasons for the denial and guide you through the appeals process.

If you believe the compensation offered is not adequate for your injuries and lost wages, legal advice can help you negotiate a better settlement. A lawyer can explain your rights under WorkCover legislation and ensure that you are receiving all the benefits you are entitled to.

How a Lawyer Can Help in the WorkCover Claim Process:

Lawyers can make sure all necessary documentation is accurate, complete, and presented effectively. In case of disputes or hearings, having legal representation ensures your case is argued effectively and your interests are protected.

Experienced lawyers can negotiate with insurance companies to secure a fair compensation package for you. They can also give advice on the legal aspects of your claim, including any potential impact on future employment and insurance issues.

Frequently Asked Questions About WorkCover Claims

Q: How long do I have to file a statutory WorkCover claim?

A: You should try to file within 20 business days of the incident to make sure you get your full entitlement to benefits. There is a strict 6 month time limit from the date of the incident, or your doctor linking your injury to your work, to make a statutory WorkCover claim.

Q: Can I return to work while my claim is being processed?

A: Yes, if you are medically fit to do so. Your doctor can advise on any work restrictions based on your condition.

Q: What if my injury gets worse after filing the claim?

A: Notify WorkCover and your employer immediately. Go and see your doctor. You may need to provide additional medical evidence to adjust your claim.

Q: Can I be fired for filing a WorkCover claim?

A: It’s illegal for an employer to terminate employment solely because an employee has filed a WorkCover claim. If this happens, seek legal advice immediately.

Make sure your WorkCover Claim is handled by the Best

At Best Injury Lawyers, we specialise in helping Brisbane people like you navigate the WorkCover system effectively.

Our experienced team is dedicated to making sure that your rights are protected and that you receive the full benefits you’re entitled to.

Whether you need help with filing a claim, assistance with a denied claim, or legal representation for negotiations, we’re here to provide the support and expertise you need.

Contact Best Injury Lawyers today to schedule a free consultation and take the first step towards securing the compensation and peace of mind you deserve.