Claim process
An insurer considers a number of criteria when deciding whether to accept a claim for worker’s compensation.
How is a claim decided?
Insurers consider 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.
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 a claim.
Sometimes different criteria might be applied to a claim. This can be the case with injuries like:
- Psychological 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 a worker is doing their 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 during a claim.
A claim will be handled by an insurer (WorkCover Queensland or a self-insurer) who will gather the information they need to make a decision as quickly as possible.
An insurer will generally contact a worker within a few business days after an application is received, to request details of the injury and any other information that’s needed.
An insurer may also speak to the employer. This is to get details of a worker’s employment and wages and to let them know a claim has been made. There may also be other details an insurer needs to clarify or confirm.
As well as speaking to a worker and their employer, an insurer may gather information from others such as doctors, any witnesses to the incident and sometimes independent medical examiners. This additional information helps an insurer to decide a claim.
Insurers aim to make a decision on claims in 20 business days or less, as outlined by legislation.
Sometimes it takes longer if an insurer hasn’t received the information they need, like details from an employer, a work capacity certificate, or certain medical information if an injury or illness is more complex.
If an insurer can’t decide a claim within 20 business days, they will contact a worker and provide the reason for the delay in writing.
If a worker is unhappy with the reasons their claim is taking longer than expected, they can ask for the Workers Compensation Regulator to review the reasons given.
If an insurer accepts a claim, there are different types of payments and support available, depending on your circumstances.
A worker may be compensated for lost wages. If this is the case, an employer will generally pay a worker’s first week's compensation (as the employer’s excess) and the employer or insurer will manage payments after that, while a worker is unable to work.
An insurer will also help a worker with other expenses relating to their claim, like rehabilitation and getting back to work.
If a claim isn’t accepted, an insurer will speak to a worker and let them know why. They will also put it in writing.
Learn more about what happens if a claim isn’t accepted and what a worker’s options are.
An injured worker might choose not to claim statutory benefits (for e.g. weekly compensation, medical expenses, rehabilitation costs etc.).
They might want to move forward with a common law claim (this means to sue their employer for damages if the employer is deemed at fault for their injury).
Keep in mind that common law claims still need to go through a similar decision-making process as outlined above.
For questions about a claim that are not answered here, the contacts below may help.
- Contact WorkCover Queensland.
- If your employer is self-insured, you can contact the relevant claims department.
- Employers can contact the Workers’ Compensation Information and Advisory Service for Employers.
- Workers and people making a claim can contact the Workers’ Compensation Information and Advisory Service for WorkersWorkers’ Compensation Information and Advisory Service for Workers.
Need urgent help?
If you, or someone you know, is experiencing a mental health crisis, call Lifeline on 13 11 14. If life is in immediate danger call 000.
It’s important that workers with a psychological injury start getting support early to help their recovery.
Getting treatment early puts a worker on the path to recovery sooner and may prevent symptoms from becoming worse.
While a claim is being assessed, a worker can usually access certain psychological health treatments funded by their insurer.
Treatment might include:
- GP mental health appointments
- counselling or psychology sessions
- psychiatry appointments
- reasonable travel expenses incurred to access and attend treatment
- medication, such as antidepressants.
What is not covered:
- in-patient hospital costs
- costs related to a hospital stay, such as nursing, or medications received in hospital.
Insurers can provide more information on how to access treatment options after a claim is lodged.
An insurer can also help with mediation services between a worker and their employer, to support recovery and getting back to work.
Please note
To access early psychological support, a worker needs to have lodged a workers’ compensation claim and have a work capacity certificate from their doctor confirming the diagnosis of a psychological injury.
If an insurer decides not to accept a worker’s claim, they will let both the worker and employer know. If this happens, funding for treatment will stop but a worker won't have to pay back the costs for treatment already received.
If a worker has had a previous workers’ compensation claim for a psychological injury caused by the same or a similar circumstances, they should talk to their insurer about whether they’ll pay for treatment while their claim is assessed.
- Lifeline 13 11 14
- Beyond Blue 1300 224 636
- Workers’ Psychological Support Service 1800 370 732 (during business hours) or email info@wpss.org.au. A free, confidential, independent and expert call back service where Queenslanders struggling psychologically due to an injury at work can access support from a social worker. Please note, this is not a crisis service.
- Suicide Call Back Service A national 24/7 telehealth provider that offers free professional phone and online counselling for people living in Australia.
- 1300 MH CALL 1300 642 255. A confidential mental health telephone service for Queenslanders linking you to public mental health services.
- QLife (LGBTIQ+) 1800 184 527 (3pm - midnight, 7 days).
- Kids Helpline 1800 55 1800. A free 24/7 online and phone counselling service for teens and young people aged up to 25.
For Aboriginal and Torres Strait Islander peoples
- 13 Yarn Crisis Support 13 92 76. 24-hour crisis support for Aboriginal and Torres Strait Islander peoples.
- Brother to Brother 24-hour crisis line 1800 435 799.
- WellMob Social, emotional and cultural wellbeing online resources for Aboriginal and Torres Strait Islander peoples.
- Black Dog Institute offers a list of support services for Aboriginal and Torres Strait Islander peoples.
Domestic and family violence support
- 1800 RESPECT 1800 737 732. 24-hour national domestic, family and sexual violence counselling, information and support service.
Emergency service workers
- The National Emergency Worker Support Service offers free and confidential mental health support for emergency service workers and volunteers (both active and retired).
Financial hardship
Victims of crime
If you’re a victim of a violent crime, you can access support through Victim Assist Queensland, and understand your rights under the Charter of Victims' Rights.
MATES in Construction
MATES in Construction supports workers in construction and mining through peer support, suicide awareness and connecting workers to mental health support services.
Workers' Compensation Information and Advisory Services
For workers and people making a claim
- Call 1800 102 166 or visit the website to submit a query online.
Free, independent and confidential information and advice to help workers and people making a claim to navigate the Queensland workers’ compensation scheme.
For employers
- Call 1300 365 855 or visit the website.
Free, independent, confidential and expert advice for Queensland employers navigating a workers’ compensation claim.