A WorkCover claim in Queensland is a formal application for compensation under the Workers' Compensation and Rehabilitation Act 2003. The Act sets out who it goes to, what must come with it and how long the insurer has to decide it. This guide covers the application itself. Reporting the injury and seeing a doctor in the first days are covered in our guide to what to do after a workplace injury.

Key points

  • You lodge the application with WorkCover Queensland online, by phone or on the paper claim form, or with your employer if it is a licensed self-insurer.
  • The application must be accompanied by a work capacity certificate from a doctor (or, in limited cases, a nurse practitioner or dentist). WorkCover says it cannot decide a claim without one.
  • The time limit is six months, with exceptions. The insurer must decide within 20 business days of the application and must give written reasons if it rejects the claim.

Who can apply

The claimant is the injured worker. If the worker cannot complete the application because of a physical or mental incapacity, the Act allows someone else to complete it on their behalf. With the worker's consent, an employer can also lodge the claim together with the worker.

Whether you are a "worker" for the scheme is not always obvious if you are paid through an ABN, a labour hire agency or a contract. The tests are set out in our guide to contractors, labour hire and ABN workers.

Where to lodge

Most Queensland employers are insured by WorkCover Queensland. WorkCover lists three ways to make a claim:

  • Online, using the claim lodgement form on WorkCover's website.
  • By phone, by calling WorkCover's claims line.
  • On paper, by completing the claim form (form FM106) and uploading it through WorkCover's online service, faxing it or posting it.

Some larger employers are licensed self-insurers. Under the Act, the "insurer" for a worker of a self-insurer is the self-insurer, not WorkCover, so the application is lodged with the employer's workers' compensation area. WorkSafe Queensland publishes the list of self-insured employers. The same Act, time limits and decision period apply.

WorkCover asks for your name, date of birth and contact details, your employer's name and location, details of how and when the injury happened, and the work capacity certificate.

The work capacity certificate

The Act requires the application to be accompanied by a certificate in the approved form from a doctor who attended you. A nurse practitioner can issue it for a minor injury and a dentist for an oral injury. In Queensland this certificate is the work capacity certificate. Physiotherapists and psychologists cannot issue one.

The certificate records the diagnosis, when and how the injury happened, the treatment you need, and whether you can work, need time off or can work with restrictions. WorkCover uses it to decide the claim, and your employer receives some of the details so it can plan suitable duties. WorkCover says it cannot decide a claim without a complete certificate and that it is the worker's responsibility to submit one. A doctor or hospital may send the certificate to WorkCover, but that does not start the claim: you still need to lodge the application.

The date matters too. Under the Act, the entitlement to compensation arises on the day a doctor (or nurse practitioner or dentist) assesses the injury, so the first visit sets the starting point for the claim.

The time limit and late applications

An application is valid only if it is lodged within six months after the entitlement to compensation arises. WorkCover describes this as six months from receiving a diagnosis. There is also a shorter timing rule: if the application is lodged more than 20 business days after the entitlement arises, compensation is generally limited to the period starting 20 business days before the application was lodged (this does not apply where the injury results in death).

The six-month limit has exceptions. The insurer may waive it if your failure to lodge in time was due to a mistake, your absence from Queensland, or a reasonable cause. WorkCover gives the example of a doctor not telling you there may be a link between your condition and your work. It may also be waived where a doctor assessed the injury as causing incapacity for work and you lodged within 20 business days of that assessment, and it must be waived if a medical assessment tribunal decides special circumstances of a medical nature exist. If you lodge late, WorkCover asks you to explain why and give information that supports it, and it may still be unable to accept the claim.

What your employer does

Separately from your application, your employer must complete an employer report in the approved form and give it to the insurer once it knows of the injury, you report it, or the insurer asks for it, whichever happens first. Failing to do so within eight business days, without a reasonable excuse, is an offence. WorkCover also contacts your employer to confirm your employment and your wages. You do not need your employer's agreement to lodge, and its report does not replace your application.

The decision

The insurer must allow or reject the application within 20 business days after it is made. WorkCover says it will usually contact you within a few business days if it needs more details, such as documents or witness contact details, and it may ask you to see an independent doctor. If the insurer does not decide in time, it must tell you in writing, within five business days, why not and that you can have the application reviewed.

If the claim is accepted, your employer pays the first week of weekly compensation as its excess, and WorkCover pays after that; how the rate is worked out is explained in our guide to WorkCover weekly payments. Reasonable medical and rehabilitation treatment is covered, and travel to treatment can be reimbursed if approved in advance. Weekly payments depend on keeping your work capacity certificates current.

If the claim is rejected, the insurer must give you written reasons. You can apply to the Workers' Compensation Regulator for a review within three months of receiving the notice. The steps are in our guide to a rejected WorkCover claim.

Keeping records

Keep your claim number and a copy of everything you lodge: the application, every work capacity certificate, the letters you receive and notes of phone calls with the date and the person you spoke to. Keep receipts for treatment and travel. WorkCover's Worker Assist app lets you manage the claim online. These records matter if a decision is reviewed, and later if a lump sum or a common law claim is considered. Our workers' compensation page explains how we can help with a WorkCover claim.

Frequently asked questions

How do I make a WorkCover claim in Queensland? Get a work capacity certificate from a doctor, then lodge the application with WorkCover Queensland online, by phone or on the paper claim form, or with your employer if it is self-insured.

Can I lodge a WorkCover claim without a work capacity certificate? The Act requires the application to be accompanied by a certificate in the approved form, and WorkCover says it cannot decide a claim without a complete one.

How long does WorkCover have to decide my claim? 20 business days after the application is made. If it does not decide in time, it must tell you why in writing, and you can have the application reviewed.

What if I missed the six-month time limit? The insurer may still accept the application if the delay was due to a mistake, your absence from Queensland or a reasonable cause. You will need to explain the delay and support it.

Sources

  • Workers' Compensation and Rehabilitation Act 2003 (Qld), ss 131 (time for applying), 132 (applying for compensation), 133 (employer's duty to report injury), 134 (decision about application), 141 (when entitlement arises), 542 (applying for review), sch 6 (definition of insurer) — legislation.qld.gov.au
  • WorkCover Queensland, How to make a claim — workcoverqld.com.au
  • WorkCover Queensland, Work capacity certificate — workcoverqld.com.au
  • WorkCover Queensland, Weekly payments and compensation — workcoverqld.com.au
  • WorkSafe Queensland, List of self-insured employers — worksafe.qld.gov.au