A Workers’ Compensation Claim Form (PDF - 170kb) is the form used for making a claim for workers’ compensation in Western Australia.

Revised workers' compensation claim form

On 1 October 2010, a revised Workers’ Compensation Claim Form (PDF - 170kb) was released. The form features a number of improvements including:

• detailed information about the claims process and entitlements
• colour-coding and checklists which make the form easier to complete
• date fields that will more accurately track delays in form lodgement
• interactive fields which make it easier to complete online and then download

Important: The process of making a claim has not changed.

A comprehensive Handy Hints brochure (PDF - 350kb) will help you complete each section of the form.

If you are having trouble filling in your claim form, first speak to your employer. If you still have questions, call Advisory Services on 1300 794 744.

The claims process

Strict timeframes apply to employers and insurers when a worker has lodged a claim form. For more information, see the Make a claim page.

Other forms for workers

• Declaration in Respect of Worker Not Residing in WA (Word - 30kb)
• Interim Payment of Statutory Entitlements (Word - 30kb)
• Workers' Compensation Claim Form for Dependants of Deceased Workers (Fatality Claims) (PDF - 30kb)