WorkCover Explained: What Is It, Who Is Eligible and How Do You Make a Claim?

Most people have heard of WorkCover, but if you are injured at work, you may suddenly find yourself asking a lot of questions.

What exactly does WorkCover cover? Am I eligible? How do I make a claim? Do I need a lawyer? What happens if my claim is rejected?

At Morgan Clifford Legal Services in Milton, Brisbane, our personal injury lawyers understand that dealing with an injury is difficult enough without also trying to navigate an unfamiliar compensation system.

Here, we explain the basics of WorkCover in Queensland and what you should know if you suffer a work-related injury or illness.

What is WorkCover?

WorkCover Queensland is the workers’ compensation insurer for most Queensland employers. Some larger employers are licensed to self-insure and manage their own workers’ compensation claims.

Queensland employers who employ workers are generally required to have workers’ compensation insurance.

The purpose of this insurance is to provide financial and practical support when a worker suffers an injury or illness because of their employment.

If a claim is accepted, workers’ compensation can provide assistance with lost wages, medical and rehabilitation expenses and, in some circumstances, lump-sum compensation for permanent impairment.

Who can make a WorkCover claim?

If you are considered a “worker” under Queensland’s workers’ compensation legislation and you suffer a work-related injury or illness, you may be eligible to make a claim.

Employees who are paid through PAYG are generally considered workers, and some contractors may also qualify depending on the circumstances of their working arrangement.

Importantly, WorkCover is not limited to obvious workplace accidents such as falling from a ladder or being injured by machinery.

Claims can potentially involve:

• physical injuries such as fractures, strains, cuts and burns
• psychological injuries
• illnesses or diseases caused by work
• existing injuries or conditions that have been aggravated by work
• some injuries sustained while travelling to or from work, travelling for work or during breaks
• serious or fatal workplace injuries.

Different eligibility requirements can apply to particular types of claims, so an injury occurring in connection with work does not automatically mean a claim will be accepted.

What should you do if you are injured at work?

There are several important steps to take.

1. Seek medical treatment

Your health should be your first priority. See a doctor or attend hospital if necessary and explain clearly how the injury occurred.

2. Obtain a Work Capacity Certificate

Ask your doctor for a work capacity certificate. This is different from an ordinary medical certificate and provides information about your injury, treatment and capacity to work.

Make sure all the injuries you want assessed are included on the certificate. A valid workers’ compensation claim requires both an application for compensation and a work capacity certificate.

3. Tell your employer

Notify your employer about the injury as soon as possible and provide them with your work capacity certificate.

4. Lodge your claim

For most Queensland workers, a claim can be lodged directly with WorkCover Queensland. If your employer is self-insured, you will generally deal with the employer’s workers’ compensation unit instead.

Is there a time limit?

Yes, and this is one reason you should not put off making enquiries.

Generally, a workers’ compensation claim should be lodged within six months from the date you were first assessed by a doctor for the work-related injury, although exceptions may apply where an insurer accepts that there was a reasonable excuse for the delay.

Other legal time limits can also apply, particularly if you may later have a common law damages claim.

Getting advice early can help ensure you understand the deadlines relevant to your individual circumstances.

What happens after you apply?

The insurer will investigate your claim and determine whether it should be accepted.

Among other things, it may consider whether you lodged your claim within the required timeframe, whether you meet the definition of a worker, whether the injury arose from a work-related incident and whether your employment was a significant contributing factor to the injury.

The insurer may obtain information from you, your employer, treating doctors and witnesses. In some circumstances, you may also be asked to attend an independent medical examination.

Insurers generally aim to decide claims within 20 business days, although complex claims or delays in obtaining information can mean the process takes longer.

What can WorkCover pay for?

If your claim is accepted, the assistance available will depend upon your circumstances.

Workers’ compensation may provide support for:

• lost wages,
• medical and rehabilitation expenses,
• certain travel expenses,
• lump-sum compensation for permanent impairment (where applicable).

The system is also designed to assist injured workers with rehabilitation and, where possible, a safe return to work.

What about a common law claim?

This is where workers’ compensation can become more complicated.

A statutory WorkCover claim is not necessarily the end of the process. If your injury occurred because your employer was negligent – for example, by failing to provide a reasonably safe workplace – you may potentially have a common law claim for damages.

Unlike a statutory WorkCover claim, a common law claim involves establishing that the employer breached its duty of care and that this caused the injury and resulting loss.

Damages may potentially include compensation for matters such as past and future loss of earnings and future medical expenses.

There can also be important consequences when deciding whether to accept a lump-sum offer for permanent impairment, particularly where the assessed degree of permanent impairment is below 20%.

It can therefore be sensible to obtain independent legal advice before accepting a lump-sum offer or making decisions that could affect your future rights.

Do I need a lawyer for a WorkCover claim?

You do not necessarily need a lawyer simply to lodge a WorkCover claim.

However, legal advice can be valuable if:

• your claim is rejected,
• your injuries are significant or ongoing,
• you are offered lump-sum compensation, or
• you want to know whether you may also have a common law claim.

At Morgan Clifford Legal Services in Milton, Brisbane, our personal injury lawyers can help you understand your rights and the options available to you following a workplace injury.

If you have been injured at work and are unsure what to do next, speak with our team. Getting advice early can help you understand the WorkCover process, important time limits and whether you may have further compensation entitlements.

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