How to make a workers compensation claim

The five clock-ins

On each scheme’s own pages the order is much the same. What changes from state to state is who does each step, what the form is called and how long each person has. The notes under each step are the rules a scheme states on its own site; a state isn’t listed where its page doesn’t say.

1. Report the injury to your employer

   Schemes ask you to tell your employer as soon as possible. A note of when and how you told them, or a copy of the email, is easy to point to later.

   VIC

   You have 30 days from the injury to report it, and WorkSafe says you should do it in writing. Your employer then notifies their WorkSafe agent.

   NSW

   Your employer must notify their claims service provider within 48 hours of you telling them. If they don’t, you or someone you nominate, such as a family member or your doctor, can notify icare online.

   TAS

   You can tell your employer in person, in writing or by email. Within 14 days they must tell you of your right to claim and give you a Notice of Right to Make a Workers Compensation Claim form.

   ACT

   Your employer must notify their insurer within 48 hours and record the injury in the workplace’s Register of Injuries.

2. See a doctor and ask for the certificate

   Each scheme has its own medical certificate, and it helps to ask for it by name. In Victoria you need one to claim weekly payments, and WorkCover Queensland says it can’t decide a claim without one.

   NSW

   A certificate of capacity, usually completed by your nominated treating doctor; each one covers up to 28 days unless the claims service provider agrees otherwise.

   VIC

   A certificate of capacity from your GP. You need it to claim weekly payments, but not for a claim for medical expenses only.

   QLD

   A work capacity certificate, which you should get at the first appointment. A hospital may send it to WorkCover for you, but that doesn’t start a claim unless you ask.

   WA

   A First Certificate of Capacity, from a doctor of your choice.

   NT

   A medical certificate of capacity. The first one can cover up to the first 14 days.

3. Fill in the claim form

   Most claim forms have a section for you and a section for your employer. Fill in yours, sign it, and keep a copy of everything you hand over.

   NSW

   Claims must be made within 6 months of the injury. With a reasonable cause, such as ignorance, mistake or absence from the state, a claim can be made within 3 years. If the injury resulted in a death or serious and permanent disablement, a claim can be made more than 3 years from the date of injury, and a claim made after 3 years needs approval from the State Insurance Regulatory Authority.

   QLD

   Lodge within 6 months of receiving a diagnosis, or within 20 business days of a doctor, nurse practitioner or dentist first assessing you as unable to work fully. You can claim online, by phone or on a paper form. If you miss the 6 month deadline, WorkCover Queensland may be able to make an exception if the delay happened because of a genuine mistake, being away from Queensland or Australia, or another reasonable cause.

   TAS

   You should usually give the form to your employer within 6 months of the injury, and before you leave if you decide to leave that job. Your employer must not stop you getting or lodging a claim form.

   NT

   NT WorkSafe’s claim form is the only approved form in the Territory, and you must sign the authority and declaration at the end of part one for the claim to be valid.

   VIC

   The Worker’s injury claim form, online or as a PDF.

4. The form goes to the insurer

   In most schemes the employer completes their part and sends the claim to their insurer. Ask your employer to confirm when they’ve sent it.

   WA

   Give the original certificate and claim form to your employer. They have seven days to complete their section and lodge both with their insurer, and penalties can apply if they don’t.

   TAS

   Your employer must tell their insurer within 3 working days that they have your claim, and send the form and certificate within 5 working days.

   NT

   Your employer has three working days to complete part two and forward the form to their insurer.

   ACT

   If you’re off work for 7 days or more, give the claim form and certificate to your employer or the insurer within 7 days, or your employer will stop paying your wages.

   SA

   The quickest way, ReturnToWorkSA says, is for your employer to make the claim online; if they can’t, you can call the claims agent.

5. The insurer decides

   Victoria and Tasmania say the decision comes in writing. Note the date it arrives: in several schemes the time to challenge a decision runs from when you receive it.

   VIC

   The WorkSafe agent has 28 days from receiving the claim to decide.

   QLD

   Most claims are decided within 20 business days, with the reasons given in writing if it takes longer.

   WA

   The insurer must give you a liability decision notice or a deferred decision notice within 14 days of receiving the claim. If it does neither, the claim is taken to have been accepted.

   TAS

   You must be told in writing within 28 days whether the claim is accepted, and a decision must be made within 84 days of lodging it.

   SA

   The claims agent aims to decide within 10 business days.

   NT

   An initial decision is due within 10 working days of the employer receiving the claim.

What to keep

Schemes ask for the same few things again and again. Keeping them together saves time when the insurer, a conciliator or a lawyer asks.

• A copy of the claim form and every medical certificate you hand over
• Treatment invoices and receipts
• Your payslips or wage details, which insurers use to work out weekly payments
• Letters and emails from your employer and the insurer, with the date each arrived
• Your own short note of how the injury happened, and who saw it

For what an accepted claim can pay, see weekly payments and medical expenses.

If the claim stalls at work

When a claim stalls with a slow or unhelpful employer, some schemes have a route around it.

• In NSW you, or someone you nominate, can notify the injury to icare online if your employer hasn’t notified their claims service provider.
• In Tasmania, if your employer doesn’t give you the notice of your right to claim, you can still make the claim yourself.
• In South Australia, if your employer can’t make the claim, you can call the claims agent.
• In the ACT, the Default Insurance Fund is a safety net for injured workers left without workers’ compensation because of their employer’s actions.

If the insurer refuses the claim, that is a decision you can challenge. The routes are set out in when a claim is disputed.

Commonwealth employees

If you work for an Australian Government department or agency, or for an organisation licensed to self-insure, your claim is usually under the Comcare scheme instead. Comcare’s steps are the same in outline: report the injury to your employer, get a medical certificate from your doctor or qualified treatment provider, and complete a claim form, with your employer or on your own. Australian Government department and agency employees submit it directly to Comcare; if you work for the ATO, Services Australia or a self-insured licensee, contact your employer about how to make a claim.