A question we hear often, usually from people working in small businesses where the owner is also a friend, is some version of "I was hurt at work, but I don't want to put in a claim against my boss". The question deserves a factual answer rather than a sales pitch, because the decision belongs to the worker. What follows is how Queensland's scheme actually works when a claim is lodged, so that the decision can be made on accurate information.

Key points

  • A statutory WorkCover claim is made to the insurer, not against the employer, and it does not allege that the employer did anything wrong.
  • The employer's direct cost is an excess equal to the first week of weekly compensation on a time-loss claim; premiums are set on wages, industry classification and, for larger employers, claims history.
  • Whether to lodge is the worker's decision alone. The Act sets a six-month limit for doing so, and an employer cannot lodge or withhold a claim on the worker's behalf.

A claim is not an accusation

Queensland's statutory scheme is no-fault. A worker applies to WorkCover Queensland, or to the employer's licensed self-insurer, and the claim is accepted if the injury arose out of or in the course of employment and employment was a significant contributing factor. Nobody has to show that the employer was careless, and accepting the claim does not find that it was. The claim is between the worker and the insurer. The employer is asked for information and is told the outcome, but it is not a party being sued. A claim for common law damages, which alleges negligence, is a separate and later step that most statutory claims never reach.

Who pays what

Every Queensland employer must hold a WorkCover accident insurance policy. When a claim is accepted, WorkCover pays the medical and rehabilitation costs, the weekly compensation during time off, and any lump sum for permanent impairment. The employer's direct contribution is the excess: on a claim that involves time off work, the employer pays the first week of weekly compensation directly to the worker, capped at Queensland full-time adult ordinary time earnings, and WorkCover takes over from there. If the worker loses no time, there is no excess.

How premiums are affected

Premiums are calculated from the employer's wages, its industry classification, and its claims experience. For employers paying under $1.5 million a year in wages, WorkCover uses a simplified model: the first $500 of claim costs each year do not count, and the policy's rating can move by at most one level, up to 10%, in a year. Employers above that wage level are experience-rated on four years of claim costs, so a serious claim does affect the premium over the following years. In other words, for a small employer a single claim has a modest and capped effect; for a large employer the effect is real but spread, and it is the purpose of the insurance the employer is paying for.

What the employer has to do

The Act gives employers obligations once an injury is reported, whether or not a claim follows: the injury must be recorded and reported to the insurer within eight business days, and if a claim is accepted the employer must take part in rehabilitation and provide suitable duties where it is reasonably practicable. An employer cannot dismiss a worker because they have made a claim, and cannot dismiss a worker solely or mainly because of a work injury within twelve months of it. These rules protect the worker, but they also describe what a reasonable employer expects to do when someone is hurt; most do it without complaint.

What the law leaves to you

Nothing in the Act requires an injured worker to lodge a claim. The application is the worker's, and an employer can neither lodge it nor stop it. What the Act does fix is time: an application must be lodged within six months of the injury, with limited scope for extension, and a worker who waits past that point to see how things go may lose the statutory entitlements altogether. Treatment costs, time off and any permanent impairment that follows are then borne by the worker or by Medicare and personal leave, not by the scheme that exists to cover them. A worker weighing the decision is entitled to know that the trade-off is theirs, and that it is a trade-off.

Talking to your employer

Many workers in this position simply tell the employer what has happened and what they intend to do. The employer has usually dealt with WorkCover before, knows that the policy is there for exactly this, and would rather the injury was properly treated and recorded than handled informally. Where an employer responds badly, the protections described above apply, and it is sensible to get advice.

Frequently asked questions

Does my WorkCover claim come out of my employer's pocket? Not beyond the excess. The employer pays the first week of weekly compensation on a time-loss claim. Treatment, further weekly payments and any lump sum are paid by WorkCover under the employer's policy.

Will my claim put my employer's premium up? For an employer with wages under $1.5 million a year, a claim has a limited and capped effect on the premium. For larger employers, claim costs feed into experience-based rating over four years.

Do I have to make a WorkCover claim if I'm injured at work? No. The decision is yours. The Act requires only that, if you do claim, the application is lodged within six months of the injury.

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