Skip to content

Claim process

When you make a claim for worker’s compensation with WorkCover Queensland (or a self-insurer), a number of things (criteria) are considered in order to decide whether to accept it.

Have you recently made a claim with WorkCover Queensland for a work-related injury or illness? Here’s what happens next.

If you’re deciding whether to make a claim, you can watch our other video, Thinking about making a WorkCover claim?

First, we look at all the information we have to decide if we can accept your claim. There’s a good chance we’ll be able to decide your claim within 10 business days.

If your claim is more complex, and it’s going to take longer than a month, we’ll let you know why there’s a delay.

If you and your employer both provide all the information we need straight away, we can generally make a quick decision.

Once your claim has been decided, we'll let you know the outcome, usually by email or SMS.

If your claim can’t be accepted, we’ll give you clear reasons why. We’ll put it in writing and include the steps you can take if you disagree.

Your claim needs to meet certain criteria to be accepted and this means we might need to ask you questions or gather more information from you.

We might also need more documents from you or from other people, like your employer or doctor.

When we decide a claim, we’ll need to know:

  • Whether you made your claim in time
  • Whether you are considered a Queensland worker
  • Where and how you were employed at the time of your injury,
  • Where and how the injury happened, and whether your work played a significant part in why you were injured.

If you don’t have one already, you should go to your doctor to get a work capacity certificate.

This is a type of medical certificate that says what your injury or illness is, what treatment you need, and if you need time off work.

Download our Worker Assist App, so you can easily stay up to date on your claim and send receipts and other documents to us.

Enter your bank details and tax file number in the app, so we can quickly pay you if your claim is accepted.

Getting better after an injury or illness at work can start now. Here are some things you can do to help:

  • Follow your doctor’s advice.
  • Keep going to your treatment and rehab appointments, and if you’ve been given exercises to do, you should keep doing these.
  • If your claim is accepted, we may be able to pay for your medical and treatment costs, so make sure you keep itemised receipts. You can check what type of treatment is covered on our website.

Mental injury claims are a bit different. We’ll usually pay for mental health treatment while we’re deciding your claim.

This might include medication or appointments with your GP or a psychologist.

Please see our website to find out more. If you’re not at work, it’s also a good idea to start talking with your employer and doctor about your recovery.

Getting back to work has been proven to help you recover sooner, even while you’re still recovering.

Your employer may be able to make changes to how, when or where you do your work to help you get back.

If you do need to take time off work and we accept your claim, we may be able to help pay some of your lost wages. How much you’ll receive is based on a few different things.

You can find out more about wages payments by searching for Payments and support on our website.

If you notice any changes in your recovery, such as your injury or illness getting worse, make an appointment with your doctor or health provider to talk about it.

Being injured at work can be difficult. We’re here to guide you and help you get your life back on track.

If there’s something you’re not sure about, you can give us a call. If we need more information from you, we’ll be in touch.

Here’s a recap of what to do while you’re waiting for your claim decision:

  • Get the treatment you need
  • Talk to your doctor and employer about any support you may need with getting back to work.

You can find the details of your claim contact in the Worker Assist App, or call 1300 362 128.

If you need help in your language call 1800 512 451 and ask for an interpreter.

You can also find out more about WorkCover claims by looking at the ‘How to guides’ on our website.

How is a claim decided?

WorkCover considers the following questions:

  • Has the claim been made in the right timeframe?
  • Was the person claiming working for the employer when they were injured?
  • Is the person claiming considered to be a worker?
  • Did a work-related incident cause the injury?
  • Was the person’s job a significant contributing factor to their injury (this means a large part of the cause)?

These criteria are set out in the Workers Compensation and Rehabilitation Act 2003 (the Act).

Are all claims decided the same way?

Every claim is different, just as every worker and injury can be different. The type of injury or how it happened can mean more information is needed to decide your claim.

Sometimes different criteria might be applied to your claim. This can be the case with injuries like:

Explore the sections below to find out what to expect with your claim.

Your claim will be handled by a WorkCover team member who, depending on the nature of your claim, will gather the information they need to make a decision for you as quickly as possible.

We’ll contact you as soon as we can (generally within a few business days) after your application has been received, so you can give us details of your injury and any other information that’s needed.

We may also speak to your employer. This is to get details of your employment and wages and to let them know a claim has been made. There may also be other details we need to clarify or confirm.

As well as speaking to you and your employer, WorkCover might gather information from others such as your doctor, any witnesses to the incident and sometimes independent medical examiners. This will help us to decide your claim.

WorkCover aims to make a decision on claims in 20 business days or less, as outlined by legislation.

If you and your employer give us the right information straight away, we can often make a decision more quickly.

Sometimes it takes longer if we can’t get the information we need, like details from your employer, your work capacity certificate, or certain medical information if your injury or illness is more complex.

If we can’t decide your claim within 20 business days, we’ll call and let you know why. We’ll also put it in writing to you.

If you’re unhappy with the reasons your claim is taking longer than expected, you can ask for the Workers Compensation Regulator to review the reasons given.

If WorkCover accepts your claim, there are different types of payments and support available, depending on your circumstances.

You may be compensated for lost wages. If this is the case, your employer will generally pay your first week's compensation (as the employer’s excess) and WorkCover will manage your payments after that, while you’re unable to work.

We’ll get your bank details and a tax declaration from you and talk to you about how you usually get paid. We’ll try to manage your payments to help minimise disruption to your normal life.

WorkCover will also help you with other expenses relating to your claim, like rehabilitation and getting you back to work.

If your claim isn’t accepted, we’ll speak to you and let you know why. We’ll also put it in writing.

Learn more about what happens if a claim isn’t accepted and what your options are.

As an injured worker, you might choose not to claim statutory benefits (for e.g. weekly compensation, medical expenses, rehabilitation costs etc.)

You might want to move forward with a common law claim (this means to sue your employer for damages if they're deemed at fault for your injury).

Keep in mind that common law claims still need to go through a similar decision-making process as outlined above.

WorkCover Queensland and self-insured employers are bound by the same workers compensation legislation.

However, a self-insured employer might have slightly different process. You should talk to your employer’s claims officer if you have questions.

If you have questions about a claim that are not answered here, the contacts below may help.