The Queensland worker’s compensation scheme is designed so that injured workers can obtain support for their recovery, including through payment of medical expenses, cover for lost wages, and compensation for the impact a work related injury has had on their lives.

The scheme is also intended to achieve:

• improved worker safety
• prevention of injuries
• effective rehabilitation and return to work programs.

This is a straightforward guide to making a WorkCover claim for workers who have been injured and anyone supporting them.

Unsure of your rights after a work injury? If you’ve suffered an injury at work due and are unsure of your rights then you should seek legal advice. Our work injury compensation experts can provide free and no obligation initial advice on your rights and explain your options including whether a no win, no fee claim for a tax-free lump sum may be possible.

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Who is entitled to make a WorkCover claim?

Workers are entitled to compensation where they have suffered a work-related injury or illness.

The law says that workers compensation can be claimed for an injury ,illness and/or death if it “arises out of, or in the course of, employment”. So, what does this mean?

Generally, an injury or illness will be considered to arise out of, or in the course of employment, if it happens while a worker is:

• at their place of employment
• somewhere else performing work duties, or because they are required to be there by their employer
• on a normal break during the workday
• travelling to or from their home to their workplace (such as a car accident on cycling injury)
• travelling to or from their home or workplace to a school or training course they are doing for work purposes
• on a journey between two workplaces

There is an additional requirement that the employment is a significant contributing factor to the injury if a claim is being made for an injury incurred at the place of employment or at another place performing work duties.

Step by step guide: making a claim to WorkCover Queensland

Obviously the first thing to be done after a workplace accident has nothing to do with claiming compensation – it is to make the workplace safe and to secure immediate medical treatment for the injured worker.

The injured worker:

• may be treated in hospital, if the injury is serious enough, or
• should consult a doctor for treatment.

If you have been injured, make sure all medical professionals are advised up front that the injuries or illness are work-related, and that a WorkCover claim may be made. This ensures that they keep suitable records for you to submit in the course of making your claim.

You should then take the following 8 steps to make your WorkCover claim.

1. Advise your employer in writing about the accident and your injuries – if you are too unwell, someone can do this on your behalf.

Your employer may already know about the accident if it happened at work, but it’s still a good idea to confirm it in writing.

2. Obtain a work capacity certificate from your treating medical professional, such as your GP or specialist. If you are treated in hospital, they can complete the work capacity certificate and forward it to WorkCover on your behalf (if you have told them it is a work-related injury).

The doctor will complete the certificate of capacity and can access guidance on how to do this effectively. For your information though, a work capacity certificate is a specific type of medical certificate that contains details about:

• the injured worker
• the injury and the circumstances in which it occurred
• what treatment plan is proposed by the doctor
• any limitations to physical functioning caused by the injury
• rehabilitation and return to work plans

3. Submit the work capacity certificate to your employer and advise them that you will be making a WorkCover claim.

4. Decide whether to make your claim to WorkCover, or to your employer. You would claim directly to your employer if they are self-insured.

How do I know if my employer is self-insured?

Most employers will be insured by WorkCover Queensland. Some, however, arrange their own workers compensation claims insurance and manage their own WorkCover claims. WorkSafe Queensland publishes a list so you can check if your employer is self-insured.

Some of the major employers on the list include:

• Brisbane City Council
• Coles
• Woolworths
• Wesfarmers - owners of Bunnings, Kmart, Officeworks and more
• Qantas

If your employer is not on that list, make your claim directly through WorkCover.

5. Submit your claim

To submit your claim, you will need to complete an online claim, or submit a claim form

A claim must be submitted within 6 months of the accident, or the date you receive a medical opinion linking your injury or illness to your work. However, it’s best to get the claim submitted as soon as you can, because if it is approved you can start receiving payments to help with your medical expenses and to cover any lost wages.

It might assist with a smooth submission of your claim if you take a little time to gather the necessary information first. This information includes:

• Personal details, including bank account information to receive payments
• Employment details
• Details of the injury
• Your work capacity certificate

If for some reason you don’t have a work capacity certificate to attach to your claim form, you will need information about:

• When the certificate was completed
• Your treating doctor and their diagnosis
• Your capacity to work
• Future treatment required

In many cases your doctor will provide a clear statement linking your injury or illness to your employment. If this is not the case, you may need further evidence to establish your entitlement to claim. This might include:

• A statement by you about how the injury occurred, or the illness came about
• If there was an accident, statements from any witnesses about what happened
• A letter or report from a doctor, specialist or other medical professional linking the injury or illness to your workplace or the performance of your work duties.

Some types of claims, like psychological injury, industrial deafness, or workplace fatalities, will require more information than others. WorkSafe Queensland provides additional guidance for claims of these kinds.

6. Provide further information to WorkCover Queensland or your self-insured employer if required.

During the claims assessment process, WorkCover (or a self-insured employer) may require additional information to determine your claim. It is best to provide the information as soon as possible.

You may also be required to have an independent medical examination.

If you are unsure about further information or assessment that has been requested, or unable to provide what is being asked of you, it may be worth seeking legal advice about your options.

7. Consider the outcome of your claim.

WorkCover Queensland aims to provide a decision on claims within 20 business days, provided all the required information has been provided.

If your claim is accepted, you will receive certain support and payments – more information about these is available here.

8. Consider all your options

A WorkCover claim is generally the most straightforward way in which to secure compensation for a workplace injury or illness. However, injured workers do have the option to make a compensation claim in the court, called a common law claim.

Some information is available from WorkSafe Queensland about the process and implications.

The seriousness of your injury will be medically assessed and the extent of any permanent impairment to your functioning will be determined. This is called a “DPI” or “degree of permanent impairment”, and is expressed as a percentage. Based on this, WorkCover will offer a lump sum payment.

If you thankfully have little permanent impairment, that is, a DPI less than 20%, you must choose whether to accept the lump sum payment or to make a common law claim. You cannot do both.

For those workers who are unfortunately more significantly impacted, with a DPI over 20%, you can accept the lump sum and still make a common law claim.

However, once you receive your Notice of Assessment and accompanying offer of lump sum compensation, it is vitally important that you seek legal advice immediately as to whether you should accept the assessment, reject the assessment or defer your decision. If you choose to accept the assessment and the accompanying lump sum offer, you will very likely lose your rights to pursue a common law claim for that injury.

You only have 20 business days in which to make a decision once the Notice of Assessment is issued. As such, you should seek legal advice immediately once you receive your Notice of Assessment. 

You can always seek advice

The steps to make a WorkCover claim are relatively straightforward, and there is much helpful information published by the government and available on the internet at the links referred to above. However, many injured workers still appreciate the assistance and advice of a lawyer experienced in workers compensation claims.

This is especially the case if you reach the point of considering whether to accept a WorkCover lump sum payment or to pursue a common law claim.