A WorkCover claim has been made. What next?
Once a claim has been made, it's allocated to a WorkCover Queensland claims representative to be determined.
We determine claims as quickly as possible and will generally contact both the worker and employer within three business days of the claim being made.
You'll have the opportunity to give details of the injury and event before we make our decision. We'll also speak to your employer to get further information (such as confirmation of employment and wage details) and to notify them that a new claim has been lodged on their policy.
How we decide a claim
When deciding a physical injury claim, WorkCover will apply criteria from the Workers' Compensation and Rehabilitation Act 2003 (the Act). Criteria can include considering whether:
- the claim was made within the time limits
- the person was employed at the time of the injury by an employer who's not self-insured
- the person is considered to be a worker
- 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.
Information to support the claim
WorkCover gathers information from the worker, employer, doctors and other people, such as witnesses to the event or independent medical examiners, to help us make our decision.
Once we've gathered enough information to decide the claim, both the worker and the employer will be informed on the decision.
If your claim is accepted, and payments are to be made to you, we will ask for your bank details to pay you. If your claim requires ongoing management or assistance with return to work, it will be case managed by a customer advisor.
Other types of claims
Depending on the type of injury or how the injury happened, WorkCover may require further information and apply slightly different criteria. These types of claims include:
- psychological and psychiatric injuries
- industrial deafness
- injuries sustained on journeys to and from work or on breaks such as morning and afternoon tea and lunch
- continuation or aggravation of an injury
- asbestos related diseases or diseases contracted in the course of employment, for example Q-fever
- fatalities caused by a work-related event or by latent onset injuries such as mesothelioma or malignant skin cancer.
How long it takes to decide a claim
When workers and employers provide true and accurate information about the claim, we are able to make a decision very quickly.
A decision on a claim can take up to 20 days, especially if we have difficulty getting the information we need such as information from the employer, the work capacity certificate or information from doctors.
If we can't determine the claim within this timeframe, we'll contact the worker verbally and in writing to let them know why a decision hasn't been made.
The worker or employer can request to have the claim reviewed by the Workers' Compensation Regulator if unhappy with the reasons provided.
Victim of Crime
If you are a victim of a violent crime, there are support services including possible financial support available to you (however any financial support will be reduced by payments received from WorkCover Queensland that were paid as a result of a claim lodged in relation to the violent crime). Information in relation to available support can be found through Victim Assist Queensland.
- Last updated
- 24 June 2016