A Step-By-Step Guide to QLD Workers’ Compensation Claims Process
When you are injured at work, knowing how to claim WorkCover QLD can be tricky. So, our step-by-step guide to work accident claims is here to help you understand the process and how to have a successful work injury payout.
How Does WorkCover Work in Queensland?
When you experience a work-related physical injury, illness, or mental health condition because of a workplace accident, your employer will have work accident insurance, known as WorkCover. The WorkCover Queensland scheme was established under the Workers’ Compensation and Rehabilitation Act 2003 to fund your insurance benefits when you claim worker’s compensation. Except in the case of self-insured employers.
What is my claim worth?
Does WorkCover Cover All Employees?
WorkCover insurance generally covers all Queensland employees for injuries sustained in work-related accidents (although some sizable employers may have self-insurer cover). This compensation insurance also includes protection for harm acquired while travelling to or from work, travel for work purposes, and injuries at work-related activities and events.
What is Covered by WorkCover?
When WorkCover approves your case, you will receive weekly payments (replacing lost wages) and your medical practitioner’s costs for things like physiotherapy, rehabilitation, GP consultations, surgery, blood tests, X-rays, scans and other required assessments or treatments.
Can I Make a Claim?
The eligibility conditions for workers’ compensations claims are outlined in the Workers Compensation and Rehabilitation Act 2003. Hence, Workcover Queensland will consider the following questions when you make a claim:
- Has the statutory claim been lodged within the right timeframe?
- Was the claimant working for the employer when they had a work related injury?
- Is the claimant considered to be a worker? (do they meet the definition)
- Was the person’s job a significant contributing factor to their injury or illness?
It can be complicated to know if you satisfy the eligibility requirements of WorkCover Queensland, but fortunately, Splatt Lawyers will assess your case for free. Call Now 1800 700 125, or use our free online claim check >
How to Claim WorkCover QLD for a Work Injury or Illness
The simplest way to claim workers’ compensation from WorkCover for a work illness or injury is to fill in and submit the online form.
However, before you do this, please review the recommended steps below to give yourself the best chance of success when you make a claim.
Steps to Making a QLD WorkCover Claim
1. Get medical attention
Please seek treatment from a doctor and provide them with information about your work-related injuries, including the physical and psychological impacts. They will generally issue you a work capacity certificate. Remember that the Queensland workplace insurer covers your medical expenses when you have an approved case.
2. Report your work-related incident
Ensure you make a work accident report as soon as you can. Be aware that time limits apply (generally 20 days), so take swift action. All employers are legally required to have an accident register or injury ledger. Another option is to file a report by lodging a compensation claim with your boss.
Please be truthful, concise, and accurate when completing this document. Do not exaggerate or embellish your condition, which could harm your case. Remember to give a copy of the completed form to your lawyer.
3. Gather supporting documents
As with all insurance claims, you will need documents to support your case, like:
- A copy of your work accident report from the employer you were working with when the illness occurred
- Medical treatment records and assessments
- Receipts for claimable expenses
If you are taking time away from work due to your harm, you will also need a certificate of capacity from your doctor. Please submit these as soon as you can.
4. Fill out and lodge your workers’ compensation claim form
First, you will need a WorkCover medical certificate from your GP. You can then begin the workers’ compensation process by lodging your WorkCover claim using the online form.
5. WorkCover Assesses Your Case
WorkCover has 20 days to decide about your case, so they will contact you to ask questions about your work and injuries. Be aware that they take notes and may record these conversations.
Likewise, they will contact your employer to discuss your pay and the circumstances of your accident.
How Does WorkCover Decide a Claim?
The process for determining the outcome of a WorkCover claim follows established guidelines and procedures. To do this, they will review the following:
- Did you lodge your case within the applicable time limit?
- Was the injured worker employed when they were harmed?
- Is the claimant classified as a worker based on legislative guidelines?
- Was there a work-related accident or event that led to your injury?
Please know that the Queensland workers’ compensation scheme is a no-fault system, so there is no need to prove who was to blame for your accident (even if you were at fault). However, you must prove liability for your loss for other types of personal injury claims (including common law claims).
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What Happens When My WorkCover Claim is Approved
When WorkCover accepts your claim, you will start to receive weekly compensation (also known as weekly payments).
The value of these payments is based on your previous 12 months’ earnings before your accident, and the calculation included factors like overtime, penalty rates, a higher duty allowance, and others.
This weekly income will not include reimbursement allowances like meals, travel, superannuation, accrued leave, and relocation expenses. WorkCover will also reimburse your work injury-related medical costs.
When Do My Payments End?
WorkCover payments end when:
- You go back to work
- Your injuries are at their highest level of improvement
- You reach the maximum value of weekly compensation
- You retire from work
How to Get the Most From Your WorkCover Payments
How you fill out your WorkCover lodgement form will determine if you get the most from your weekly payments. So be sure to submit your correct pay rate, including any regular shift loadings and allowances. Contact your HR department if you are still determining your salary and entitlements.
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What If My Workers Compensation Claim is Denied or Rejected
When workers’ compensation claims are denied or rejected, that is rarely the end of the matter. Of course, you will be disappointed at this outcome, but you can still pursue your case.
Sometimes, WorkCover rejects a case because the insurance company does not believe your physical or mental damage is work-related or your employer challenges your side’s version of events. However, a claim rejection can be an opportunity for a thorough investigation of your circumstances and an improved chance of presenting your situation.
Role of the Workers Compensation Regulator
The role of the workers compensation regulator is to internally review the insurer’s decision. This responsibility extends to:
- Rejected applications, including a decision to deny compensation, a service or payment
- A decision that an injured worker is not entitled to care, treatment and support payments
- A decision to terminate benefits or to refuse an examination application
- Deciding that a worker’s serious injury is unlikely to continue to satisfy Chapter 4A conditions (for serious personal injuries) after the interim period ends.
- Refusing to accept liability to make treatment, care and benefit payments, including when the claimant is absent from Australia,
Legal Help with QLD Workcover Claims Disputes
If you believe your case has been denied unfairly, you should seek legal advice from an experienced work injury lawyer. Splatt Lawyers has been challenging the rights of injured workers for nearly three decades, including negotiating with the workers compensation regulator.
Our Queensland personal injury law firm provides 100% with no win, no fee legal services to all our valued clients, which means you pay when you win, and nothing if you lose. Get immediate legal support now by Calling 1800 700 125.
What Are Some of the Injuries Covered by WorkCover Insurance?
Any work-related accident or event that causes a physical or psychological injury or escalates a pre-existing ailment can qualify for WorkCover benefits. However, some common injuries are:
- Back and spinal
- Lifting injuries
- Mental Health
- Slips, trips and falls
- Collision with a static object
- Shoulder and rotator cuff
- Head and neck damage
- Muscular Damages
- Repetitive strain
- Post Traumatic Stress Disorder (PTSD)
- Work-related stress and depression
- Industrial Deafness or Hearing Loss
- Eyesight damage
- Severe Burns
- Permanent injuries
Work-Related Psychological Injuries
Your work can damage your mental health in many ways, and when this happens, you could have a WorkCover psychological injury claim. However, it’s not enough to have emotional damage from your job. To succeed, you must have a recognised psychological or psychiatric disorder like:
- PTSD
- Adjustment disorder
- Depression
- Anxiety disorders
- Bipolar affective disorder
- Dissociative disorder
- Schizophrenia
- Psychosis
- Obsessive-compulsive Disorder
Remember, you can also seek compensation when your job worsens a pre-existing injury. These types of claims are challenging because your harm is not visible. Working with an experienced psychiatric injury lawyer is your best chance of success.
More about work-related mental illness >
Do I Have a Valid Claim?
Other Workers Cover QLD Claims
Lump Sum WorkCover Payouts
You could also pursue a lump sum WorkCover payout when you have a severe work-related injury that leads to permanent impairment.
Common Law Damages
You can make a common law claim if your employer’s negligence (in other words, when your boss breached) their legal duty of care) was the cause of your injury. WorkCover Queensland must accept a statutory claim before you can file a common law claim against your employer. In this situation, you are suing your employer for your loss. When successful, the insurance company will fund your common law damages by paying your lump sum compensation.
How Our Expert Workers Compensation Claim Lawyers Help
Navigating the Queensland Workers Compensation System to access your owed work injury insurance benefits can be difficult. So, our work injury lawyers will support you in the process of making a claim, providing effective legal representation and reliable advice.
We aim to deliver your best legal outcome by ensuring you know your entitlements and right to claim. Please get in touch for expert workers’ compensation legal advice if you have encountered any of the following:
- A work-related injury
- A mental health injury caused by your job
- Your work escalated a pre-existing injury, illness or psychological disorder
- WorkCover rejects your work injury case
- The insurance company won’t pay for something
- The insurer denies medical treatment or surgery.
- You have not had legal advice for a work injury
- You want to know how to get a lump sum payout
- Your boss is trying to make you return to work
- You want to know your legal rights
Remember, knowing where you stand is free, and you owe nothing until we win your case. Find out how we can help you by Calling – 1800 700 125.
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Workers Cover Queensland FAQs
How much does WorkCover payout in Qld?
According to WorkSafe QLD statistics, the average common law payout for work-related injuries was $188,794 in the 2022–2023 period.
On the other hand, the value of a lump sum payout under a statutory claim is $3,805.75 for each 1% of permanent impairment as assessed using the ISV scale.
What is the maximum payout for workers’ compensation in Qld?
Section 140 of the Workers Compensation and Rehabilitation Act 2003 states, that the ‘maximum statutory compensation’ payable for an injury or multiple injuries sustained in a single event, is defined as being 216.15 times the Queensland full-time adult’s Ordinary Time Earnings (QOTE).”
In Queensland, the QOTE for the period July 2023 to June 2024 is $1,760.70. The maximum statutory compensation amount is $380,575.31 after multiplying this number by 216.15.
How long does a WorkCover claim take in Qld?
WorkCover has 20 days to determine the outcome of statutory claims for workers’ compensation benefits. On the other hand, common law cases typically take two years or longer to resolve, though some do so in less than a year, depending on the case’s complexity.
How do I lodge a QLD WorkCover claim?
The simplest way to claim WorkCover is to complete and lodge the online form. Then, speak with a workers compensation lawyer to learn about your rights.