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.
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:
- Psychological and psychiatric injuries
- Industrial deafness
- Injuries travelling to from or for work or on scheduled breaks
- Aggravated injuries or ongoing symptoms
- Work-related respiratory diseases or diseases contracted while doing your job, for example Q-fever
- Death caused by a work-related event or by illnesses like mesothelioma or malignant skin cancer, that develop over a long period of time (called ‘latent onset’).
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.
- Call WorkCover Queensland on 1300 362 128
- If your employer self-insures, you can contact the relevant claims department
- Employers can contact CCIQ’s Workers’ Compensation Helpline
- Workers can contact the Queensland Council of Unions’ Workers’ Compensation Advisory Service