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Understanding the workers’ compensation process helps you and your workers

Best practice

Understanding the workers’ compensation claims process and openly sharing this information with your workers will better prepare them for if an injury occurs.

Why this is important

Workplaces that support workers to report work-related injuries and if necessary, lodge a claim are also more likely to experience injured workers safely staying at or returning earlier to work.1

Your toolkit

  • Understand the two different types of claims a person can make for a work-related injury:
    • A statutory claim – a no fault claim where a worker is paid for their weekly benefits and/or medical and rehabilitation expenses for a specified period.
    • A common law claim – a claim where negligence or fault on the part of an employer is proven and a worker receives a payment of damages for their past and future economic loss (income, medical expenses etc.) and pain and suffering.

Some workers will make a claim for both statutory compensation and common law damages.

The statutory claims process involves the following steps:

  1. A worker sustains a work-related injury or illness that requires medical treatment, rehabilitation and/or time away from work.
  2. The injured worker makes a workers’ compensation claim with their insurer (for most workplaces, this is WorkCover Queensland unless their employer is a self-insurer) within six months.
    • Ideally, the injured worker and their employer complete the claim application together.
    • The employer must also report the work-related injury to their insurer within eight days of becoming aware of it.
  3. The insurer will decide the claim within 20 days and may consider whether the application was lodged on time, whether the person qualifies as a ‘worker’ in Queensland, and whether the injury sustained was work-related.
  4. If the claim is accepted:
    • Weekly benefits and/or medical expenses may be paid.
    • A rehabilitation and return to work plan must be developed.
    • Rehabilitation will be arranged as needed, including suitable duties to enable an early return to safe work, or a host employment program for injuries where the worker is unable to return to their original job.
    • As an employer, if you disagree with the decision to accept the claim, you can ask the reasons for the decision and why it was decided. An employer also has the right to request an independent review by the Workers’ Compensation Regulator.

    If the claim is rejected:

    • The worker is provided with reasons why, and has the right to request an independent review of the decision.
  5. When the worker’s injuries have stabilised, or the worker is back at work to full capacity:
    1. The claim can be terminated or ceased, and weekly benefits and/or medical expenses will no longer be paid.
    2. OR

    3. The claimant can ask the insurer to be assessed for a degree of permanent impairment (DPI) by a panel of independent medical experts.
      • For psychological injuries, only the Medical Assessment Tribunals (MATs) can assess DPI.
      • For physical injuries, if the claimant disagrees with the DPI provided by the insurer, the matter can be referred to the MATs.

1 The ‘Australian workers’ understanding of workers’ compensation systems’ report  Safe Work Australia