Can I make a claim for workers' compensation?

You are entitled to make a claim if you sustain an injury in the course of your employment and are defined by law as a worker.

The legal definition of a worker includes full-time, part-time, casual, seasonal, piece and commission workers. Working directors, contractors and sub-contractors, and members of the employer's family dwelling in the same house may also be defined as workers depending on their working arrangements.

When can I make a claim for workers' compensation?

You can make a claim for workers' compensation if you suffer any of the following, and any one of them results in time off work or requires medical treatment.

• a personal injury by accident arising out of, or in the course of employment, or while acting on the employer's instructions
• a disabling disease
• a disease contracted in the course of employment, or the recurrence or aggravation of a pre-existing disease where the employment contributed to a significant degree

How do I make a claim?

If you are injured, follow these steps to make a claim for workers’ compensation.

1. Immediately seek first aid and report the injury to your employer.
2. As soon as possible, see the doctor of your choice and ask for a First Medical Certificate (Word - 250kb).
3. Fill out a Workers’ Compensation Claim Form (PDF - 170kb). If you have difficulty completing the form, first speak to your employer - if you are still unsure, contact Advisory Services.
4. Take a copy for yourself of the Certificate and Claim Form, and then give both to your employer.
5. Your employer has five working days to pass the Certificate and Claim Form onto their insurer.
6. The insurer will notify you within 14 days after receiving your claim form. The notification will indicate if the claim has been:
   • Accepted
     If your injury prevents you from working, your employer must commence making weekly compensation payments. Payments will be made on your normal payday for the duration of the medically-certified period of your incapacity.
   • Disputed
     If your claim is disputed, no compensation will be paid and the insurer will advise you of the reason. If you disagree with the insurer’s decision, you can approach the insurer to re-evaluate the decision. If still unresolved, you should lodge an application with the Conciliation and Arbitration Services (CAS) for an independent review as soon as possible. If you do not apply to resolve the dispute, the insurer may consider your claim dismissed.
   • Held / Pended
     On some occasions the insurer may put your claim on hold pending further information. The insurer then has another 10 days to make a decision on your claim. If the claim is still undecided after the 10 days have passed, the claim is deemed to be in dispute. You may lodge an application with the CAS to have the matter decided.

Note: The Best Practice Guidelines for Insurers (PDF - 230kb) have been developed by insurers to ensure claims are dealt with quickly. However, if you do not hear anything from the insurer or your employer within 19 days of lodging your claim, you may lodge an application with the CAS.

Review by employer’s medical practitioner

Your employer or their insurer may refer you to a medical practitioner of their choice before or after your claim has been accepted. You are required to attend this appointment for medical examination only.

You cannot be required to attend medical reviews:

• more frequently than once every two weeks
• at any time other than during reasonable hours
• with more than three medical practitioners who are specialists in the same field of medicine.

If you do not attend an appointment without a reasonable excuse, refuse to submit yourself for examination, or in any way obstruct the examination, your right to compensation may be suspended.

Return to work

If your doctor indicates on your Certificate that you have total capacity to return to work, it’s likely you’ll return to your previously held position. If you are reluctant to return to that position, or your doctor assesses that you have only partial capacity to return to work, your employer will consult with you in implementing a return to work program. For more information, see the Returning to Work section.