This section includes forms required for claims, disputes and general administrative processes within the scheme.

If you require help when filling out any forms, please contact Advice and Assistance on 1300 794 744.

To order any of our publications please complete the Publications Order Form (Word or Fillable PDF) and send to communications@workcover.wa.gov.au

Fact Sheet – Who is WorkCover WA? (Accessible PDF – 585KB)
This fact sheet outlines the role of WorkCover WA in the workers’ compensation and injury management scheme.

Workers
Worker forms
Workers' compensation claim form
  • Workers’ Compensation Claim Form (PDF – 101KB) (Fillable PDF – 1MB)
    The claim form includes information on the claims process and your rights, responsibilities and entitlements when making a claim for workers’ compensation.


  • Handy Hints Brochure (PDF – 370KB)
    This comprehensive guide to the Workers’ Compensation Claim Form will help you complete each section of the form.

Claim form for dependants of deceased workers

Dependants of deceased workers should refer to Workplace fatality claims for further information about making a claim.

Common law forms
Medical forms
  • Workplace Rehabilitation Referral Form (Word – 99kb)
    This form can be used by workers, employers or treating medical practitioners to request a referral to a workplace rehabilitation provider.


  • Form 6: Declaration of worker not residing in Western Australia (Word – 26kb, Fillable PDF – 136kb)
    This form is used to declare an injured workers’ incapacity when the injured worker does not reside in Western Australia.
Noise induced hearing loss forms
Dispute resolution forms

Workers’ Compensation and Injury Management Conciliation Rules 2011 (External Link)
The Conciliation Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Conciliation Rules.


Conciliation forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronically writeable and printable version of the Form 100 – Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.



Workers’ Compensation and Injury Management Arbitration Rules 2011 (External Link)
The Arbitration Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Arbitration Rules.


Arbitration forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.



Prescribed forms

Certain forms are prescribed by the Workers’ Compensation and Injury Management Regulations 1982.

As prescribed forms, their format cannot be altered. Where a form is required at a particular stage in the process, it should be filled out in the format provided.


Worker publications
Worker guides
Noise induced hearing loss
Contractors & sub-contractors
Industrial diseases
Employers
Employer forms
Injury management & return to work
  • Template Injury Management System (Word – 52kb)
    This template will assist employers to devise an appropriate injury management system for their workplace.


  • Template Return to Work Program (Word – 108kb)
    This template will assist employers to devise an appropriate Return to Work Program collaboratively with the injured worker.


  • Workplace Rehabilitation Referral Form (Word – 99kb)
    This form can be used by workers, employers or treating medical practitioners to request a referral to a workplace rehabilitation provider.


  • Form 6: Declaration of worker not residing in Western Australia (Word – 26kb, Fillable PDF – 136kb)
    This form is used to declare an injured workers’ incapacity when the injured worker does not reside in Western Australia.
Noise induced hearing loss
General forms for employers
Dispute resolution forms

Workers’ Compensation and Injury Management Conciliation Rules 2011 (External Link)
The Conciliation Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Conciliation Rules.


Conciliation forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronically writeable and printable version of the Form 100 – Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.



Workers’ Compensation and Injury Management Arbitration Rules 2011 (External Link)
The Arbitration Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Arbitration Rules.


Arbitration forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.



Prescribed forms

Certain forms are prescribed by the Workers’ Compensation and Injury Management Regulations 1982.

As prescribed forms, their format cannot be altered. Where a form is required at a particular stage in the process, it should be filled out in the format provided.


Employer publications
Employer guides

  • Fact sheet – Case Conferences (Fillable PDF – 535kb)
    This fact sheet outlines how a case conference can assist all parties involved in a claim to help an injured worker return to work.
Contractors & sub-contractors
Noise induced hearing loss
Interstate workers

Resolving a dispute forms
Conciliation rules & forms

Workers’ Compensation and Injury Management Conciliation Rules 2011 (External Link)
The Conciliation Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Conciliation Rules.


Conciliation forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronically writeable and printable version of the Form 100 – Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.


Arbitration rules & forms

Workers’ Compensation and Injury Management Arbitration Rules 2011 (External Link)
The Arbitration Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Arbitration Rules.


Arbitration forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.


Prescribed forms

Certain forms are prescribed by the Workers’ Compensation and Injury Management Regulations 1982.

As prescribed forms, their format cannot be altered. Where a form is required at a particular stage in the process, it should be filled out in the format provided.


Resolving a dispute publications
Conciliation publications
Arbitration publications
Health provider resources
General practitioners

General practitioners perform an integral function in progressing the medical forms for workers’ compensation claims.

General practitioners and medical practitioners are encouraged to use WorkCover WA’s gpsupport website to access a number of supporting resources.

First Certificate of Capacity

Progress Certificate of Capacity

Final Certificate of Capacity

Allied health providers
Allied health providers are encouraged to access the Clinical Framework for the Delivery of Health Services.

The Clinical Framework for the Delivery of Health Services (Clinical Framework) is an evidence-based guide designed to support healthcare practitioners delivering services to people with compensable injuries. Developed by the Transport Accident Commission (TAC) and the Victorian WorkCover Authority, this framework reflects contemporary research and has been widely endorsed by Australian workers’ compensation jurisdictions, as well as peak health associations.

The Clinical Framework outlines five principles shown to deliver optimal recovery and return to work outcomes for injured workers. The principles are:

  1. measure and demonstrate the effectiveness of treatment
  2. adopt a biopsychosocial approach
  3. empower the injured person to manage their injury
  4. implement goals focused on optimising function, participation and return to work
  5. base treatment on best available research evidence

We encourage you to use and share the framework with your colleagues, patients (injured workers), employers and workplace rehabilitation providers in working towards optimal outcomes in recovery and return to work.

Approved medical specialists
Forms

Publications
AMS Application Packs
Workplace rehabilitation providers

Register of approved workplace rehabilitation providers (WorkCover WA Online)
A register of all WorkCover WA approved workplace rehabilitation providers (WRPs).

Completed applications should be emailed to records@workcover.wa.gov.au.

Applications to become an approved workplace rehabilitation provider Renewal applications Principles and Standards

Note: “Workplace Rehabilitation” means “Vocational Rehabilitation” as stated in the Workers’ Compensation and Injury Management Act 1981.

WorkCover WA Online
Forms and templates
Hearing testers

Forms
Worker/employer forms
Publications and fact sheets
General resources
  • Fact sheet – Case Conferences (Fillable PDF – 535kb)
    This fact sheet outlines how a case conference can assist all parties involved in a claim to help an injured worker return to work.
Service provider resources
Insurers
Insurer and Self-Insurer Principles and Standards of Practice

The Principles and Standards outline WorkCover WA’s baseline expectations of insurers and self-insurers operating in the scheme.

An interactive self-assessment tool to assist case managers reflect on their practices and processes in adherence to the Principles and Standards.

Claims Managers Capability Framework

The Claims Managers Capability Framework sets out the practices, skills and behaviours expected of claims managers in the Western Australia workers’ compensation scheme.

The Capability Framework translates the Insurer and Self-insurer Principles and Standards of Practice into observable practices and behaviours which claims managers should demonstrate when delivering scheme services.

Claims Managers Capability Framework (PDF – 473kb)

Clinical Framework

The Clinical Framework for the Delivery of Health Services (Clinical Framework) is an evidence-based guide designed to support healthcare practitioners delivering services to people with compensable injuries. Developed by the Transport Accident Commission (TAC) and the Victorian WorkCover Authority, this framework reflects contemporary research and has been widely endorsed by Australian workers’ compensation jurisdictions, as well as peak health associations.

The Clinical Framework outlines five principles shown to deliver optimal recovery and return to work outcomes for injured workers. The principles are:

  1. measure and demonstrate the effectiveness of treatment
  2. adopt a biopsychosocial approach
  3. empower the injured person to manage their injury
  4. implement goals focused on optimising function, participation and return to work
  5. base treatment on best available research evidence

We encourage you to use and share the framework with your colleagues, patients (injured workers), employers and workplace rehabilitation providers in working towards optimal outcomes in recovery and return to work.

Electronic Data Specification Guidelines and Forms - Insurers

WorkCover WA requires additional data from insurers for monitoring scheme performance and setting recommended premium rates. This data is required to be submitted in accordance to the guidelines. Please note, with exception of WC20-Semi-Annual 2022/23 returns, all the Forms are now required to be submitted via WorkCover WA Online. Insurers have the option of emailing the WC20-Semi-Annual 2022/23 returns using the WC20-Semi-Annual Form.

General

Forms

Guidelines

Sample Data

 

Previous Year's Guidelines

WorkCover WA requires additional data from insurers and self-insurers for monitoring scheme performance and setting recommended premium rates. This data is required to be submitted in accordance to the guidelines. Please note that the WC12 Form is now required to be submitted via WorkCover WA Online.

General

Forms

Guidelines

Guidelines and Forms - Self-Insurers

WorkCover WA requires additional data from self-insurers for monitoring scheme performance and setting recommended premium rates. This data is required to be submitted in accordance to the guidelines. Please note, with exception of WC20-Semi-Annual 2022/23 returns, all the Forms are now required to be submitted via WorkCover WA Online. Insurers have the option of emailing the WC20-Semi-Annual 2022/23 returns using the WC20-Semi-Annual Form.

General

Forms

Guidelines

Sample Data

 

Previous Year's Guidelines

WorkCover WA requires additional data from insurers and self-insurers for monitoring scheme performance and setting recommended premium rates. This data is required to be submitted in accordance to the guidelines. Please note that the WC12 Form is now required to be submitted via WorkCover WA Online.

General

Forms

Guidelines

General publications
Greater than 75% loading applications Workplace fatalities
Insurance brokers

Insurance Brokers’ Code of Practice (PDF – 905kb)
The Code was developed collaboratively by WorkCover WA and the National Insurance Brokers Association (NIBA) to provide clear guidelines for insurance brokers operating within the workers’ compensation system and assist you to meet your professional obligations.

Employer resources
Forms
  • Template Injury Management System (Word – 52kb)
    This template will assist employers to devise an appropriate injury management system for their workplace.


  • Template Return to Work Program (Word – 108kb)
    This template will assist employers to devise an appropriate Return to Work Program collaboratively with the injured worker.


  • Workplace Rehabilitation Referral Form (Word – 99kb)
    This form can be used by workers, employers or treating medical practitioners to request a referral to a workplace rehabilitation provider.


  • Form 6: Declaration of worker not residing in Western Australia (Word – 26kb, Fillable PDF – 136kb)
    This form is used to declare an injured workers’ incapacity when the injured worker does not reside in Western Australia.


Publications



Registered agents

Register of Registered Agents

See the current list of registered agents.

Applying for or renewing registration
Regulations
Costs determination
Information for clients
Legal practitioners
Conciliation rules and forms

Workers’ Compensation and Injury Management Conciliation Rules 2011 (External Link)
The Conciliation Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Conciliation Rules.


Conciliation forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronically writeable and printable version of the Form 100 – Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.


Arbitration rules and forms

Workers’ Compensation and Injury Management Arbitration Rules 2011 (External Link)
The Arbitration Rules support the arrangements for resolving workers’ compensation disputes in Western Australia. All parties to a dispute need to comply with the Arbitration Rules.


Arbitration forms

Online lodgement

WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.

Forms

Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.


Previous legal decisions

A party to a dispute in the Workers’ Compensation Arbitration Service may appeal to the District Court of Western Australia against a decision of an Arbitrator. In any other case, leave to appeal may be granted where a question of law is involved.

An appeal to the District Court must be made within 28 days from when the Arbitrator provides the parties with the written reasons for the determination.

The District Court may affirm, vary, quash, substitute or make an addition to the original Arbitrator decision.

Accessing previous decisions

The jurisdiction or authority that deals with appeals depends upon when the appeal was made.

December 2011 - present

Appeals from the Workers’ Compensation Arbitration Service have been heard by the District Court of Western Australia. These decisions can be accessed via the eCourts portal.

1994 - November 2011

Previous decisions of the Commissioner and Compensation Magistrate can now be accessed via WorkCover WA Online. Information about how to register for WorkCover WA Online can be found here.

November 2005 – November 2011

The Commissioner dealt with matters regarding:

  • a novel or complex question of law referred by an arbitrator
  • a question of law referred by a party to the proceeding before an arbitrator
  • appeals against a decision of an arbitrator.

 

1994 – November 2005

The Compensation Magistrate dealt with:

  • a novel or complex question of law referred by a review officer
  • a question of law referred by a party to the proceeding before a review officer
  • appeals against a decision of a review officer.
Costs determination
General resources
  • Fact sheet – Case Conferences (Fillable PDF – 535kb)
    This fact sheet outlines how a case conference can assist all parties involved in a claim to help an injured worker return to work.