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WorkCover claims process (Qld)

Connor Boccalatte
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25 October 2022

The WorkCover claims process in Queensland

In Queensland, employees who suffer a work-related injury or an illnesses in the course of their employment are able to make a claim for compensation for any loss of income and for payment of medical expenses as a result.

All employees, from full-time to part-time to casual workers, are covered by their employer’s workers’ compensation insurance, if they are injured at work or due to their work.

Each employer or business may have their own insurer however, in Queensland, the primary method of making a claim is through WorkCover QLD.

This is known as a “statutory claim”, and  can be done either by submitting an online claim, posting a claim form to WorkCover, or calling their telephone line for assistance on 1300 362 128. If your employer is a self-insurer, you will need to make a claim through them.

Under the Workers Compensation and Rehabilitation Act 2003 (“WCRA”), an application must be lodged by the injured worker within six (6) months’ of the injury.

What should I do if I am injured at work?

If you suffer an injury or illness at work, you should follow the following steps:

  1. See your doctor immediately or go to the hospital immediately for initial treatment.
  2. Obtain a work capacity certificate from your treating doctor to confirm the injury is work-related.
  3. Let your direct supervisor at work know what has happened as soon as you can and give them your work capacity certificate.
  4. Make a claim with WorkCover (or talk to your employer if they are self-insured). We will also need a copy of your work capacity certificate as WorkCover can only provide support from the date your doctor first assessed your injury.
  5. Begin rehabilitation as soon as you can. This will help your recovery and your employer is obligated to help you with this.
  6. Obtain a copy of the incident report and any statement you provide, relating to your injury. You can then seek our assistance and provide us with copies of same.
  7. If you are a mine worker, we recommend that you also cooperate with any investigation and participate with any interviews with the Department of Resources and Mining Inspectorates.

Your employer has a duty to assist you in making a WorkCover Claim if you are injured or suffer an illness in the course of your employment. You should also report any serious injury to Workplace Health and Safety, once you have received medical treatment.

Claims made to WorkCover are regulated under the WCRA. A successful claim will meet the following criteria:

  • Has the claim been made in the right timeframe, being within 6 months of the injury?
  • Was the person injured working for the employer when they were injured? This can be found in PAYG statements, pay slips or other such documents.
  • Is the person claiming considered to be a worker? Again, this can be found in PAYG statements, pay slips or other such documents.
  • Did a work-related incident cause the injury?
  • Was the person’s job a significant contributing factor to their injury?

What if WorkCover rejects your claim

If WorkCover rejects your application for a compensation claim, you may have this decision externally reviewed by the Worker’s Compensation Regulator (WCR). You will have three (3) months from the date of WorkCover’s decision to apply for the review.

The WCR will review the application and WorkCover’s findings to determine if the application should be rejected. This review is a free service however, no new evidence is obtained by the WCR in making their decision.

If the WCR agrees with WorkCover and also rejects your application, you may apply to the Office of Industrial Relations. However, fees may be payable if you require representation or assistance from a third party.

What happens when WorkCover accepts your claim?

If WorkCover accepts your claim, they will offer you payments for medical expenses and loss of income and support, and possibly a lump sum payment in consideration of the degree of permanent impairment (DPI) relevant to your injuries once full rehabilitation and treatment has occurred.

Whilst you are receiving benefits from WorkCover, they will liaise directly with you to determine the appropriate support and treatment you require to get you back into the work force with minimal disruption to you.

WorkCover may have you medically-assessed by their preferred physicians and specialists to help determine if or when you may be able to return to your employment, or possibly another role which is suitable to your restrictions and abilities.

If you cannot return to your full duties, WorkCover will encourage you to return to work on “suitable duties” which will be a program/roster that you are medically-cleared to commence.

If your employer cannot offer suitable duties, WorkCover may offer an opportunity to enter a “Recover at Work” Program, where you will be placed with a “host employer” who is able to provide suitable duties and support to you while you recover.

If you are considered by a medical professional to have recovered from your injuries, WorkCover will cease benefits. Alternatively, if you have suffered ongoing symptoms from your injury/illness, you can request a Notice of Assessment from WorkCover for DPI.

Notice of Assessment

A Notice of Assessment involves a medical examination from a specialist to determine if you have suffered any permanent impairment from your injury/illness. The specialist will provide their opinion for WorkCover’s consideration, who will then assign a percentage of degree of permanent impairment (DPI). This percentage will entitle you to a certain lump sum amount of compensation to permanently resolve the matter.

If your DPI is less than 20% and you accept the offer from WorkCover, the matter will be settled once and for all and no further claim for compensation will be permitted, such as a Common Law Claim.

If your DPI is 20% or more, you will be entitled to accept a lump sum offer of compensation and still make a common law claim for compensation.

Reviewing the Notice of Assessment and Offer

Alternatively, if you dispute the percentage of permanent impairment and offer of lump sum compensation, you may have the Notice of Assessment reviewed by an independent specialist. You will be required to be examined again, by the second specialist at WorkCover’s expense, who will provide their own opinion as to your degree of permanent impairment resulting from your injury/illness.

WorkCover will then re-evaluate their offer based on the second opinion and possibly increase, decrease or keep the same offer of lump sum compensation to you.

WorkCover is required to decide within 10 business days of receiving the Notice of Assessment response whether to have the injury re-assessed by a different doctor or refer it to the MAT.

If you still disagree with the offer, you may have it reviewed by an Independent Medical Tribunal, who will consider the two assessments performed to date and provide their own findings. The Tribunal’s decision of three (3) doctors is final and cannot be reviewed.

Please note that for psychiatric injuries, the assessment must be conducted by the General Medical Assessment Tribunal (GMAT). This decision is also final and there is no review process for these assessments.

For physical injuries, if the worker disagrees with the original assessment, they can request referral to the MAT or ask the insurer to consider a medical review by a different doctor. The medical review process is a new step in the assessment process.

Our experts are able to help you understand and make an informed decision on your Notice of Assessment if, for example, an injury has not been adequately assessed or missed completely.

Rejecting the Offer

If you are unsatisfied with your claim outcome, you may choose to defer or not accept the statutory WorkCover payment offered to you. You may then be able to make a common law claim.

Again, if your DPI is less than 20%, you must reject the offer of lump sum compensation to make a common law claim. If your DPI is 20% or more, then you can accept WorkCover’s offer and also make a common law claim.

If you have suffered an injury or illness at work and have needed to take time off work, we recommend you seek medical treatment, and report the incident to your employer to make an application to WorkCover.

The Compensation Team at Wallace & Wallace Lawyers are experienced in all aspects of Workers Compensation legislation. If you are dissatisfied with your current representation, our experts can also offer a second opinion.

If you, or if you know someone who has been injured at work or is unhappy with a decision of WorkCover, or you want a second opinion, call us now on (07) 4963 2000 or contact us via our online contact form for practical legal advice on how you should proceed. We can assist.