In Queensland, if you have suffered injury at your workplace, you are covered by workers’ compensation insurance. What is WorkCover Queensland? For most Queensland employees, it is the insurance company which provides insurance for work injuries.
How does WorkCover work? Every employer must have Workcover insurance, so that if you suffer a work injury and can’t work, you still have the certainty that your income will continue to be paid to you.
WorkCover is there to pay your wages and medical bills. This includes GP consultations, surgery costs, Xray/MRI costs, physio sessions and any other necessary treatment costs.
This means that when you are off work, you still receive your weekly wages and your medical costs are paid for.
Every worker is covered for injuries that happen at work. On top of that, in some instances injuries that happen on the way to work or home (from work) are also covered.
If you have suffered an injury at work, here is what you need to do to get started with your Queensland WorkCover claim.
Step #1: Medical Treatment
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.
If your physical condition permits you to do so, you should let your supervisor know as soon as possible. Be accurate but keep it short. You may be asked to fill out an incident report, which is fine.
Keep in mind, if you need to go to the hospital or to a GP, your costs will be paid in the Workcover claim process.
Step #2: How To Lodge Your WorkCover Claim (Important Time Limits in Queensland WorkCover claims)
There are two types of claims: a statutory claim and a common law claim. After you suffer an injury, you begin by lodging a statutory claim.
The basic steps in lodging the claim are:
The Work Capacity Certificate will be given to you by your doctor when you visit them after the injury.
When you prepare the claim form just prior to lodging, your employer must assist you if you require this. However, you do not have to let them do this with you. If you want to deal with WorkCover directly, that’s fine.
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 #3: WorkCover decides whether to accept or reject the claim
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.
What questions will Workcover ask after an injury?
They will want you to tell 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.
Step #4: After WorkCover accepts your claim…
If Workcover accepts your workers compensation claim then it will start paying your weekly wages. This is called your weekly compensation payment.
In some cases, WorkCover may find that your injury is an aggravation of a pre-existing condition. Read about this more here.
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.
Weekly wages does not include, for example, travel, meal, relocation allowances, super, accrued holidays.
WorkCover will also pay your medical bills. 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 will also pay the costs of any necessary surgery.
Step #5: WorkCover Wants To End Payments…
WorkCover will end your payments when:
When your treating specialist believes that your injuries are stable and stationary (meaning that they won’t get any better or worse), WorkCover will send you for an Independent Medical Examination. The IME is performed by a specialist. WorkCover chooses the specialist.
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%.
WorkCover will give you a Notice of Assessment. 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 can get you much more than what WorkCover offers in the Notice of Assessment.
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 complete 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.
BONUS TIP: Don’t fall for this trick
Sometimes we come across situations where you suffer an injury at work, and a few weeks or months later something happens at home or while you are outside which makes the injury worse. As soon as you report this, WorkCover will try and allege that your original work injury had healed already, and the new injury (i.e. what you suffered later at home) has nothing to do with your work injury. WorkCover does this because this is how it might try to close your claim.
With a lot of different injuries (for example spinal injuries) you might feel that a few weeks or months on the injury is better or even fully resolved. This is often because you are off work and you don’t put pressure on yourself. This does not mean that the original injury is in fact resolved in a medical sense. In other words, even if you then “aggravate” it at home, this may still be connected to the work injury, and you should still be entitled to compensation.
Many firms try to rush you to sign up with them without carefully considering your options. We encourage you to first learn about your personal injury claim. You should ask yourself:
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