How is a WorkCover Claim Processed?

Last updated on November 1st, 2022 at 02:53 pm

As there are a number of legal requirements associated with making a WorkCover claim, we recommend seeking legal advice before you begin proceedings. However, to help you understand how claims are processed, we’ve put together this guide on how compensation claims are handled.

How Are WorkCover Claims Assessed?

When you suffer from a work injury and submit a WorkCover claim, it is assessed against the criteria set out in the Workers’ Compensation and Rehabilitation Act (2003). The Act states that a number of different factors must then be considered, including whether:

• The claim was made within the time limits
• The person was employed by the employer at the time of the incident and is considered to be ‘a worker’
• The injury was caused by a work-related event
• The employment was a significant contributing factor to the injury

Depending on the nature of the injuries sustained, different criteria may apply, or extra information may be required. This includes psychological trauma, industrial deafness and aggravated injuries.

How is my WorkCover Claim Processed?

Once you make a WorkCover claim, it will be allocated to a WorkCover Queensland claims representative. While assessing your compensation claim, the representative will contact both the employer and the claimant. Usually, this contact is made within three working days of submission.

Your employer will usually be contacted to confirm any information you have submitted, such as your employment information and your wage details. The representative will also notify your employer that you have made a claim against them, if you have not done so already.

When the representative contacts you, they will ask you for further details on any of the information you have submitted, including the type of work injury you suffered and the extent of it. You may also be asked for a full version of events and be given an opportunity to expand on any of the circumstances surrounding the event.

The claims form, any other evidence submitted (such as witness statements) and both discussions will then be used to make a decision on your workplace injury claim.

How Long Until My WorkCover Claim is Decided?

As long as both you and your employer provide true and accurate information regarding your claim, a decision will be made quickly based on the information provided.

However, if you and your employer disagree on certain details, or certain evidence regarding the claim has not been received (such as a work capacity certificate or information from a doctor), then it can take up to 20 business days to make a decision.

If a decision on liability cannot be reached within 20 days, then WorkCover Queensland will contact you verbally and in writing, outlining why a decision has not been made yet. Usually, this is because information relating to the claim needs to be clarified by the employer or your doctor. However, if you’re unhappy with the reasons given, then you can contact the Workers’ Compensation Regulator, who will review the claim.

How Will I Know if My Work Injury Claim Has Been Accepted?

Once all information has been received, both you and your employer will be informed whether your claim has been accepted or rejected.

If your claim is successful, then you will start receiving weekly compensation immediately, with your employer paying the first payment. Further payments will then be managed by WorkCover, who will confirm all necessary details with you. 

If your claim is rejected, then you’ll be spoken to by a claims representative and you will receive a letter explaining why your claim was rejected. If you disagree with the decision, you have a right to have the case reviewed.

If you’ve been injured at work and are considering submitting a WorkCover claim, then please contact us, as strict time limits apply.