WorkCover QLD: A Complete Guide to Understanding Your Rights

An injury on the job can completely upend your life. WorkCover Queensland is the scheme that covers most Queensland workers, but figuring out its processes, what you’re eligible for, and your entitlements is not always straightforward. This guide covers the basics in plain-English.

What is WorkCover QLD?

WorkCover Queensland administers Queensland’s workers compensation scheme.  Most workers injured at work in Queensland lodge a claim with WorkCover Queensland. WorkCover manages your claim, pays for your treatment and pays you weekly compensation while you recover.

THE WORKCOVER CLAIM PROCESS IN PLAIN LANGUAGE

WorkCover Queensland is not a court process. It is an insurance scheme. When you are injured, you lodge a claim with WorkCover. If it is accepted, WorkCover covers your medical treatment and pays you while you cannot work and you are receiving treatment. You deal with WorkCover (rather than your employer directly) for most of the financial aspects of your recovery from injury.

Queensland workers’ compensation is a no-fault insurance scheme managed by WorkCover Queensland. If you’ve been injured at work, you can access the workers’ compensation scheme regardless of who was at fault for your injury.  The scheme is administered through the Workers Compensation and Rehabilitation Act 2003 (QLD). 

All employers in Queensland except where specifically exempt are required to have workers’ compensation insurance with WorkCover Queensland. Some large employers are approved to self-insure; however they remain subject to the same laws.

WORKCOVER VS COMMON LAW CLAIM

WorkCover and common law are two separate pathways. WorkCover provides access to Queensland’s statutory workers’ compensation scheme which covers your medical costs and income, which you are receiving treatment. You can make a common law claim for damages (including damages for pain and suffering) if your employer was negligent. You may have access to both, but they operate differently. This guide focuses on the WorkCover statutory scheme.

Who Does WorkCover Cover?

Most employees in Queensland are covered by workers’ compensation.  Whether you’re a full-timer, part-timer, casual, trainee, apprentice or seasonal worker, you’re covered by the scheme.

Under the Workers’ Compensation and Rehabilitation Act 2003 (Qld), a “worker” is generally an individual who works under a contract and is an employee for PAYG withholding purposes. Only an individual can be a worker.

People usually not considered workers include:

1. Company directors working for their own company: A person is not a worker if they perform work under a contract of service with a corporation of which they are a director.
2. Trustees working for their own trust: A person is not a worker if they perform work under a contract of service with a trust of which they are a trustee.
3. Partners working for their own partnership: A person is not a worker if they perform work under a contract of service with a partnership of which they are a member.
4. People working for the Commonwealth or a Commonwealth authority: They are expressly excluded in Schedule 2, Part 2.
5. Professional sportspersons, while competing, training, preparing, doing related promotional activities, or travelling in connection with those activities.
6. Fishing crew paid mainly by a share of the catch/profits, where remuneration depends on the ship producing gross earnings or profits.
7. Driving instructors using their own vehicle under a contract that is not a contract of service.
8. People in approved work-for-unemployment-payment programs under the Social Security Act.
9. People with a personal services business determination in effect for the work.

Practically, the most common exclusion you’ll see is: directors, trustees and partners are usually not “workers” for their own entity, even if they are doing day-to-day work in the business. Also, many genuine independent contractors are not workers, but that depends on the actual arrangement. WorkSafe Queensland notes that all PAYG employees and some contractors are generally workers, but there are exceptions and the employee/contractor distinction turns on the working arrangement.

LABOUR HIRE AND CONTRACTING ARRANGEMENTS

Labour hire employees placed by a labour hire company are generally covered by WorkCover as employees of that company. They are not covered as independent contractors. Likewise, some people who may contractually describe their working relationship as “contracting” will be covered by the Act because their working arrangements are considered employment. If you have been told you are an independent contractor, but your working arrangements are like those of an employee, don’t assume you aren’t covered.

What Injuries Can I Claim For?

WorkCover covers injuries which are caused by your work or a work-related activity. This includes psychological injuries, as well as occupational diseases and aggravation of pre-existing conditions.

Injuries that can be claimed for include:

• Physical injuries at the workplace or on a work journey, including injuries travelling between work location
• Injuries that occur during an authorised recess or activity connected to work
• Gradual onset physical conditions caused by the nature or demands of the work
• Psychological injuries including PTSD, anxiety, and depression caused by work events or conditions
• Occupational diseases caused by exposure to substances or conditions in the workplace
• Aggravation of a pre-existing condition, where the aggravation is work-related

Injuries usually not covered include:

1. Injuries not sufficiently connected to work
   For example, an injury that did not arise out of or in the course of employment, or where employment was not a significant contributing factor.
2. Psychological or psychiatric injuries caused by reasonable management action, taken in a reasonable way
   This is the major exclusion for psychological injury claims. Reasonable management action can include things like performance management, disciplinary action, transfer, demotion, redeployment, retrenchment, or dismissal, provided the action and the way it was taken were reasonable.
3. Psychological or psychiatric injuries caused by the worker’s expectation or perception of reasonable management action
   For example, stress caused by anticipating a performance meeting or disciplinary process may be excluded if the underlying management action was reasonable.
4. Psychological or psychiatric injuries caused by action by the Regulator or insurer in connection with the worker’s compensation application
   These are also carved out of the definition of compensable “injury” in the Act.
5. Non-personal injury losses
   The scheme is about injury to a worker. Pure financial loss, hurt feelings without a recognised injury, workplace conflict without a diagnosable injury, or inconvenience alone will not usually be covered.
6. Conditions where work is only a minor or insignificant factor
   A pre-existing condition can be covered if work significantly aggravates it, but not where the work contribution is trivial or unrelated.

INJURIES WHICH ARE PRE-EXISTING CONDITIONS

If you already suffer from a condition and work aggravated that condition, you may still claim. WorkCover accepts claims for aggravation of pre-existing conditions. They need to be work-related though. If you’re injured and WorkCover raises the issue of a pre-existing condition, seek advice.

How Do I Make a WorkCover Claim?

Making a claim is not complicated, but getting the steps right from the outset makes everything that follows easier.

1. Report the injury to your employerTell your employer you’ve been injured as soon as possible.   There is no set form required at this stage. Tell your supervisor or manager what happened and when. Your employer is required to record the injury in their official injury register.  This creates an early record of the incident, which is important for your claim.  You should also keep your own record.  A good idea is to email your supervisor with what you’ve told them so you know there is a written record.  Keep a copy of any incident report completed with your employer.Delaying this step can allow WorkCover to question whether your injury is work related. Always report an injury, even if it seems minor.
2. See a doctor and get a certificate of capacitySee a doctor as soon as you can after the injury. Tell the doctor the injury happened at work. The doctor will provide a certificate of capacity, which sets out your injury, your treatment needs, and your capacity for work.  This certificate is a necessary document to provide to WorkCover as part of your claim.Keep all medical certificates and records of treatment from this point forward.
3. Lodge a claim with WorkCover You can lodge your claim online through the WorkCover Queensland website, by phone or through your employer. You don’t need to tell your employer you are making a claim, and you don’t need your employer’s permission to make a claim. You’ll need your details, details about the injury and your certificate of capacity. Your employer is required to help you lodge your claim and cannot impede the process.  If they do, call WorkCover directly yourself.The six-month time limit for lodging runs from the date of injury, or when your injury is diagnosed as work related. Lodge as early as possible.

    

4. WorkCover accepts or rejects your claimWorkCover will investigate your claim and decide, usually within 20 business days. If the claim is accepted, your entitlements begin. If the claim is rejected, you have the right to dispute the decision. WorkCover must give you reasons for any rejection.
5. Manage your claim through recoveryOnce your claim is running, WorkCover will assign a case manager to your claim. The case manager coordinates your treatment, your return-to-work plan, and your ongoing payments. You are expected to participate actively in your recovery and return to work where your capacity allows. WorkCover bases their decision on medical evidence.  It is your responsibility to seek and organise treatment.  If you are not happy with the treatment you are receiving, go to another doctor and get a second opinion.You have the right to dispute decisions about your treatment, your capacity, and your return-to-work arrangements. See below for your rights under the Act.

DO NOT DELAY

There is a six-month time limit for lodging a WorkCover claim from the date of the injury. For gradual onset injuries, the clock runs from the date you became aware of the injury and its work connection. Claims lodged after six months can still be accepted but require a specific application and a good reason for the delay. Do not assume you have time to wait.

What You Can Claim

The WorkCover statutory scheme covers a range of entitlements. These are not automatic. You need an accepted claim first, and the entitlements available to you depend on your injury and your capacity for work.

Weekly Compensation

If you’re injured and can’t work or can only work reduced hours you may be entitled to weekly compensation from WorkCover. This payment is based on your normal earnings up to the maximum amount set by the legislation. These payments taper off over time as you are expected to progress toward returning to work.

The amount payable depends on factors such as your normal weekly earnings, whether you are totally or partially unfit for work, how long you have been receiving payments, and whether an industrial award or agreement applies. As a general guide, many people receive about 85% of their normal weekly earnings for the first 26 weeks.

After the first 26 weeks, weekly payments usually to 75% of your normal weekly earnings or a percentage of Queensland Ordinary Time Earnings, depending on your circumstances. If you remain unfit for work after 2 years, the rate may reduce again unless the injury is serious enough that it could result in a degree of permanent impairment of more than 15%. For people below that threshold, weekly payments drop to the pension rate. This is why it is important for injured workers to understand not only their initial WorkCover payments, but also how those payments may change over time if their recovery takes longer than expected.

All payments stop after 5 years, or when the statutory cap is reached.

Medical and Treatment Expenses

All reasonable medical expenses incurred for the treatment of your work injury are covered. This includes doctors, specialists, physiotherapy, psychology, occupational therapy, imaging costs, and pharmaceutical medications which relate to your injury.

Rehabilitation costs

WorkCover will cover the cost of work-related rehabilitation. This can include occupational therapy, physiotherapy and other allied health treatment which is related to your recovery and return to work.

Lump sum for permanent impairment
You may be entitled to a lump sum payment if you suffer a permanent impairment because of your injury.  The amount is calculated using the degree of permanent impairment (DPI) assessed by a medical specialist, multiplied by a statutory rate.  The assessment process is formal, and its outcome has flow on effects for common law claims. You can view the statutory rates here.

Hospital and surgery costs
Hospital admissions and surgical procedures related to the accepted injury are covered where WorkCover approves the treatment. Prior approval may be required for elective procedures.

Return to work support
If you are unable to return to your pre-injury position, WorkCover can pay for retraining, job placement services and other programs to help you back to work.

What the statutory scheme does not cover is pain and suffering compensation and economic loss beyond the defined weekly payment rates. Those are available through a common law claim if your employer was negligent and you meet the eligibility threshold.

Queensland Workers: Your Rights

Workers have rights under the Workers Compensation and Rehabilitation Act. The main things to know are:

You have the right to make a claim without retaliation. Your employer can’t punish you for making or intending to make a WorkCover claim. They can’t sack you, downgrade your position or reduce your hours because you’ve made a claim. Adverse action against workers who make a claim is expressly prohibited by law.

You have the right to choose your treating doctor. Just because your employer has a preferred doctor doesn’t mean you have to see them. You can choose who you want to treat you.

You have the right to dispute decisions. If WorkCover makes a decision about your claim that you don’t agree with including a rejection, reduction in payments or decision about your capacity, you can have that decision reviewed.

You have a right to information. WorkCover must provide you with reasons for decisions that affect your claim. You are entitled to access information about your claim on request.

DON’T BE INTIMIDATED

Just because you have rights doesn’t mean you won’t be pressured or misled. If you feel like your employer, your case manager or WorkCover are ignoring your rights, say something. It’s not acceptable and there are formal dispute resolution processes for a reason.

If WorkCover rejects your claim?

Workcover can reject a claim for various reasons. The most common reasons are: they believe your injury did not occur at work; the injury did not occur because of work; your claim was lodged late; or you have not provided enough medical evidence to support your injury.  Just because WorkCover reject your claim doesn’t mean you shouldn’t pursue it. You have the right to request a review of WorkCover’s decision.

The disputes process
If your claim is denied or WorkCover makes a decision you think is incorrect, the first step is to request that WorkCover review the decision internally. You have 3 months to do this from the date of the decision. If an internal review is unsuccessful, you can take your complaint to the Queensland Industrial Relations Commission (or the courts) depending on the nature of the dispute.

The process has strict time limits at each stage of the process. Do not let that window pass while waiting to see if things improve.

GETTING ADVICE ON A REJECTED CLAIM

Some rejected claims are won on review, and some are not. Whether a particular rejection can be successfully disputed will depend on the reasons provided for the rejection and what evidence you can present to prove them wrong. Before you decide to fight a decision, it’s wise to get some guidance on whether it’s winnable and what the process entails.

Common Law Claims: The Other Pathway

The WorkCover statutory scheme is not the only legal pathway available to injured workers. If your employer’s negligence contributed to your injury, you may also have access to a common law claim for damages.

A common law claim allows you to claim damages for pain and suffering, and for economic loss beyond what the statutory scheme covers. To succeed, you need to establish that your employer was negligent and that their negligence caused or contributed to your injury. You also need to meet a threshold level of injury severity assessed under the scheme.

Common law claims in Queensland fall under the regulations of the Workers’ Compensation and Rehabilitation Act 2003.  The claim runs alongside and after the statutory WorkCover process, not instead of it. There are specific procedural requirements and the interaction between the two pathways is complex.

DO NOT NAVIGATE BOTH PATHWAYS ALONE

The interaction between the statutory WorkCover claim and a potential common law claim is one of the more complex areas of personal injury law in Queensland. Decisions made in the statutory process, particularly around the Notice of Assessment, have direct consequences for common law options. Getting advice before those decisions are made produces better outcomes than trying to understand the interaction after the fact.