What happens when you make a WorkCover claim?

18/03/2019

It has been our experience that there can be a lot of confusion about what happens when you make a WorkCover claim. Workers entitled to make a WorkCover claim for work related injuries do not always lodge them when they absolutely should. This can be for all sorts of reasons but often uncertainty about the process is the key reason people do not lodge their claim.

Our team at Gorgon Legal are here to help fill in the blanks and explain how the process works. We have put together some helpful information which explains a little about what’s involved when you lodge a WorkCover claim.

Starting your WorkCover claim

If you have sustained an injury at work or you have an injury caused by work-related tasks then you have 30 days from the date of the incident to report your injury to your employer. Your injury report to your employer is not the same as your WorkCover claim and your claim form must be filled out and lodged separately.

When should you lodge your claim form?

You should fill out and lodge your WorkCover claim as soon as possible. Forms can be downloaded online at www.worksafe.vic.gov.au or found at an Australia Post Office. There are two ways you can lodge your claim form. You can lodge your claim form with your employer or you can choose to post your claim form directly to WorkSafe. We recommend that if you choose to post your claim form then you do so via registered post and retain your records should you ever need to return to them at a later date in the claim process.

The more records you have then the easier it will be to stay on top of your claim. Keep everything safe and together. This might include doctor’s and specialist’s letters, certificates, scans, results, correspondence from and to your employer. Everything related to your injury and your claim should be kept together for quick and easy reference.

How long will you wait to hear the outcome of your WorkCover claim?

Once you have lodged your claim, your employer has 10 days to lodge their own claim with their WorkCover insurer. Their WorkCover insurer then has 28 days to advise you of whether your claim has been accepted or rejected. If your claim has been rejected by the WorkCover insurer then you have 60 days to lodge your dispute against their decision.

We can provide expert assistance with your dispute process. Contact us on 1800 21 22 23 or via our enquiry form to find out more information.

Are you entitled to weekly payments from WorkCover?

To be entitled for weekly payments from WorkCover you must provide a Certificate of Capacity. This certificate is obtained by your doctor or treatment provider and will cover you for a period of 14 days. If you require weekly payments thereafter then you will need to provide a Certificate of Capacity every 28 days.

What happens when your claim has been accepted?

Once your claim has been accepted by your employer’s WorkCover insurer, your employer must provide suitable employment for your capacity to work for up to 52 weeks. This means that your employer must find alternative work for you to do, and which you are capable of doing, for up to a year. Any reasonable medical and treatment related expenses are also paid once your claim has been accepted.

You are entitled to choose your own treatment provider/s and doctors, however, ensure that your treatment provider/s requests permission from the WorkCover insurer for any treatments that you undertake. This will ensure that you are not left out of pocket if your WorkCover insurer does not cover a particular treatment option.

What happens if your claim is not accepted?

You are able to dispute an insurer’s decision using the dispute resolution process as managed by the Accident Compensation Conciliation Service (ACCS). This process does not incur any cost to you.

For more information on how to manage your WorkCover claim, or your dispute, please contact our team on 1800 21 22 23 or via our online enquiry form.