In Queensland, if you have suffered injury at your workplace, there are two types of claims which you can make. Because every employee is covered by workers’ compensation insurance, the first type of claim is a statutory workers’ compensation insurance claim. This ensures that in the short to medium term the workers’ compensation insurer pays your weekly wages and medical bills. Secondly, you later on can make a common law damages claim. This allows you to receive extra financial compensation for pain and suffering, past and future income loss, lost superannuation, future surgery costs and more.

Below is a brief overview of how to make a statutory workers’ compensation claim. We commonly deal with work injuries involving:

FLY IN FLY OUT (FIFO) WORKERS

MINE WORKERS

CONSTRUCTION WORKERS

PERSONAL CARERS

LABOUR HIRE WORKERS

Statutory workers’ compensation insurance claim

The workers’ compensation insurer (in most cases WorkCover Queensland) is there to pay your weekly wages and medical bills  (including GP consultations, surgery costs, Xray/MRI costs, physio sessions and any other necessary treatment costs.)

Every Queensland worker is covered by workers’ compensation insurance, so if your injury happens at work, you can make a claim. On top of that, in some instances injuries that happen on the way to work or to home (from work) are also covered.

How to make a workers’ compensation insurance claim in Queensland?

Step #1. Get immediate medical attention. We have had cases where the employer expected our client to sign a written statement while they were still in pain in the immediate aftermath of the incident. You are not obligated to sign any statement while you are in need of medical attention. When your physical condition permits you to do so, you should let your supervisor know about your injury as soon as possible.  Be accurate but keep it short. You may be asked to fill out an incident report, which is fine.

Step #2. Get a Work Capacity Certificate from your doctor.

Step #3. Lodge a Claim Form with WorkCover online here or find the paper form here. If your employer is self-insured, ask your employer for the details of the self insurance department. Lodge your claim as soon as possible. In Queensland, a workcover claim for compensation needs to be lodged within 20 business days of injury, or else WorkCover may deny paying you for the period of the delay. Also, the claim must be lodged at the latest within 6 months of injury or you may lose your rights altogether.

Step #4. WorkCover has to make a decision within 20 business days whether to accept your claim. To do so, WorkCover will contact you and ask questions about your injury and your employment. They will want you to tell them when the incident happened, where and how. They will also ask about your injuries. Be truthful, but know that everything you say is recorded and WorkCover keeps notes. WorkCover will also contact the employer. They will ask questions about your weekly wages. They will also ask the employer to try and confirm how the work accident happened.

After WorkCover accepts your claim…

If Workcover accepts your workers compensation claim then it will start paying your weekly wages.  Your weekly wages are calculated based on your earnings in the 12 months before the injury. It includes your wages, regular overtime, higher duties, penalty rates and certain allowances. This is called your weekly compensation payment.  Weekly wages do not include, for example, travel, meal, relocation allowances, super, accrued holidays.

WorkCover will also pay your medical expenses, including the costs of any necessary surgery.  It’s important to understand that you have the right to use your own doctor. You may be required to undergo a rehabilitation program. For example, if you suffered spinal injuries, you may need to undergo physiotherapy sessions. WorkCover may nominate a provider for this. But if you are not happy with them, you can request a change and in most cases this can be arranged.

WorkCover wants to end payments…

WorkCover will end your payments when:

• you return to work
• your injuries won’t improve anymore (see our guide on Independent Medical Examination)
• you receive the maximum amount of weekly compensation
• you retire

What is a WorkCover Queensland IME?

There comes a time in your claim when WorkCover sends you to an Independent Medical Examination. The IME is performed by a specialist. WorkCover chooses the specialist – this will be different from your treating doctor/surgeon.

You will be sent for an IME for one of two reasons. Firstly, if your treating doctor or specialist thinks you need surgery, then before WorkCover agrees to fund the cost, it will ask the IME specialist whether the surgery is really necessary. Secondly, after a while WorkCover will want to know if your condition has reached the stable and stationary stage. Stable and stationary doesn’t mean you have recovered, it just means that your condition won’t improve. It also means WorkCover can close your claim and get you off the books.

If the specialist believes your injuries are stable and stationary, they will advise WorkCover about your degree of permanent impairment. For example, they might say your degree of permanent impairment is 11%.

Notice of assessment

After the IME, if your condition is deemed stable and stationary, WorkCover will give you a Notice of Assessment. (If they don’t, you can ask for this.) If you have suffered a degree of permanent impairment,  WorkCover will offer you a lump sum compensation amount. We recommend that you seek legal advice before deciding to accept the lump sum compensation amount.

In most cases, if you accept the lump sum compensation amount, you lose your right to make a common law claim for damages. A common law claim for damages may get you much more than what WorkCover offers in the Notice of Assessment.

Aggravation of pre-existing condition in Workcover claims

Sometimes Workcover will accept your claim as an aggravation of a pre-existing condition. What does this mean? Let’s say a couple of years ago you injured your back.  That injury did not completely resolve. Let’s assume that you have now injured your back at work again. The new injury has worsened your initial injury. This is called an aggravation.

If your aggravation happens at work, you are entitled to workers compensation. However, WorkCover will only pay your medical bills and compensation to the extent that these relate to the aggravation. In practice, it is often very difficult to determine what is the original injury and what is the aggravation.