Receiving and managing claims

When a worker completes and provides to you a Workers’ Compensation Claim Form accompanied by a First Certificate of Capacity, you have five working days to pass the documents to your insurer (take a copy for your records, and provide a copy to the worker).

It is not your decision to accept liability for the claim. Your insurer must assess the claim and advise you and the injured worker of their decision, in writing, within 14 days of receiving the claim. The advice must indicate whether it is accepted or disputed, or if they need more time to make a decision.

Claims that involve a journey

An injured worker is entitled to choose their own medical practitioner for diagnosis and treatment.

An injured worker cannot be required to attend medical appointments arranged by you or your insurer more than once every two weeks and only during reasonable hours.

If you would like a second opinion, you can request a medical review through your insurer.

A worker also cannot be required to see more than three medical practitioners who are specialists in the same field.

An employer cannot insist on being present at an injured worker’s medical appointment.

If a worker’s claim is accepted, their medical bills can usually be forwarded straight to the insurer for payment.

Prior to commencing any treatment, the worker should be advised to check with your insurer that any proposed treatments will be covered and costs reimbursed.

Click for information about employer attendance at medical consultations (PDF – 151KB).

Your insurance policy will detail what you can expect from your insurer. The best way you can assist your insurer is by immediately providing them with any relevant information you obtain regarding an injured worker. You should involve them as soon as possible after the injury occurs.

Getting feedback from your insurer

Ask your insurer for feedback regarding all claims, and consider arranging regular meetings. You can expect your insurer to inform you of the following:

• the cost of any claims made on your policy at least once a year
• any dispute referred to the Workers’ Compensation Conciliation Service and the outcomes of each stage of the dispute
• the renewal date for your policy.

While the claim is being assessed If the claim is accepted

Employers must keep an injured worker’s position available (where reasonably practicable) for 12 months from the day the worker is entitled to receive weekly payments.

If your injured worker attains partial or total capacity to work during this time, you must provide their original position (where reasonably practicable), or another of equal status and pay for which they are qualified and capable of performing.

Intention to dismiss the worker

During the 12 month period, if you intend to dismiss your injured worker, 28 days’ notice of that intention must be given to them and to WorkCover WA by completing Form 15G – Notice of Intention to Dismiss a Worker.

WorkCover WA will then determine if any further information is required, and a Compliance Officer may contact you to discuss details of the termination.

Note: If your worker is in receipt of weekly payments at the time of dismissal, they will continue to receive statutory weekly payments and medical/related benefits.

Returning to work is the outcome you, your injured worker and their doctor work towards. In some cases, an injured worker may be left with a permanent impairment or incapacity for work which entitles them to a lump sum payment to finalise their workers’ compensation claim.

In order to access certain benefits or settlements, or pursue common law damages, it may be necessary for your injured worker to obtain an impairment assessment from an approved medical specialist of their choice.

Impairment assessments are usually required when you (or your insurer) and your injured worker have not agreed on a level of impairment.

What is an approved medical specialist? How the worker gets an assessment