How workers’ compensation claims are determined

Mine site

When it comes to workers’ compensation insurance in Queensland, some employers and workers might wonder how we make decisions on claims.

It’s a step by step process and we follow what is set out in legislation – the Queensland Workers’ Compensation and Rehabilitation Act 2003. We appreciate legislation can be complicated, but we’ll try to explain the principles simply in this article, which appeared in the latest edition of the Queensland Mining and Energy Bulletin.

Injuries fall into a number of categories, put simply ‘general’ cover and ‘other types’ of cover. Under ‘general cover’ we’ve included:

  • Physical injuries
  • Psychological injuries
  • Journey claims
  • Industrial deafness.

‘Other cover’ includes fatal injuries and latent onset injuries, which are more complex. Policy holders and claimants can contact WorkCover Queensland on 1300 362 128 for more information on these types of claims.

General cover - Physical injuries

We look at several things involving the worker, the timeframe and the event.

  • the claim was made within the time limits (six months from the date first seen by a doctor for the work related injury)
  • the person was employed at the time of the injury by an employer who's not self-insured
  • the worker’s employment is connected to the state of Queensland
  • the person is considered to be a worker - we use the Australian Taxation Office (ATO) determination tool to help here. There are some exclusions – Directors of a corporation, trustee of a trust, partner of a partnership.
  • the injury was caused by a work-related event, and
  • the person was injured because of, or in the course of, employment if the employment is a significant contributing factor to the injury.

More information can be found here.

Event

Under the Workers Compensation and Rehabilitation Act the meaning of an event is:

  • Anything that results in injury, including latent onset injury, to a worker
  • It includes continuous or repeated exposure to substantially the same conditions that result in an injury to a worker
  • A worker may sustain one or multiple injuries as a result of an event whether the injury happens or injuries happens immediately or over a period of time
  • If multiple injuries result from an event, they are taken to have happened in one event.

Psychological injuries

When making a decision on a psychological or psychiatric injury, employment needs to be the major significant contributing factor to the personal injury.

An injury does not include a psychiatric or psychological disorder arising out of, or in the course of, any of the following circumstances:

  • reasonable management action taken in a reasonable way by the employer in connection with a worker's employment
  • a worker's expectation or perception of reasonable management action being taken against a worker
  • actions by the authority or an insurer in connection with a worker's application for compensation.

Examples of actions that may be reasonable management actions taken in a reasonable way include: 

  • action taken to transfer, demote, discipline, redeploy, retrench or dismiss a worker
  • a decision not to award or provide promotion, reclassification (or transfer of), leave of absence or benefit in connection with the worker's employment.

Journey claims

Due to the nature of the mining industry, with Fly In Fly Out (FIFO) arrangements, we’re often asked about how journey claims work in the mining industry.

Journey claims are recorded separately to workplace injury claims and do not impact on the employer’s premium. Some examples of journey claims which may be accepted:

  • Driving to the airport from your house to catch a plane to work (with no deviations or significant delays or break any road traffic rules)
  • Driving from camp to home (with no deviations or significant delays or break any road traffic rules)
  • Being tired and delaying your trip home to the following day so you can have a sleep in your donga, as per your employer’s recommendation.

If an injury occurs within your home or the boundary of your home, you have not begun your journey and therefore will not be entitled to compensation.

Industrial deafness

Industrial deafness is the loss of hearing caused by working in a noisy environment over a period of time. It's different to hearing loss that is the result of a single event.

To make an industrial deafness claim, you must:

  • provide a workers' compensation medical certificate that diagnoses your industrial deafness
  • make the claim while you're either:
    • considered a worker under the Workers' Compensation and Rehabilitation Act 2003
    • temporarily unemployed, but would normally be considered a worker, or
    • within 12 months of formal retirement
    • have been employed for at least five years in an employment where the noise level was a significant contributing factor to your industrial deafness.

WorkCover Queensland Customer Service Manager, Mining, Matt Cross has some advice for businesses and their employees. Check out his seven tips and tricks to help with determining claims:

  • Encourage employees to complete incident reports for near misses as well as injuries. This is preferable at the time of the event taking place.
  • Provide the incident report and any other supporting material to WorkCover as soon as possible
  • Try to provide responses to WorkCover as quickly as possible
  • Keep records of all incidents and injuries
  • Provide suitable duties if medically possible
  • If the worker and doctors will allow, accompany your worker to the doctor to enable discussion about the possible return to work on suitable duties
  • In Queensland, only the insurer can cover the cost of any work related injury. The sooner we are notified, the sooner we can help with recovery and return to work.

For more information, please review the useful links below, contact your WorkCover Queensland Relationship Manager, or call 1300 362 128.

Useful links

Injuries at work

Stay at work/return to work

Recover at Work

Last updated
05 July 2016