How to know whether a WorkCover claim has been made

Has a workcover claim been made

You will know a WorkCover claim has been made in Victoria when a workers injury claim form has been completed and lodged, and you have received confirmation of the claim being received by the WorkCover insurance company.

The workers claim form must be completed

In order to initiate a WorkCover claim, you, the injured worker, must complete a workers injury claim form.

You must complete this form, sign it and dated and then lodge it.

More on lodging the claim form later on down the page.

This is the only way in which a workers compensation claim can be initiated under the Victorian WorkCover scheme (that being said there are a couple of exceptions but for the vast majority of people this is the only way).

This means that if you have not completed, dated signed and lodged this particular claim form, a WorkCover claim has not been lodged.

Here are a few examples where a person might believe they have had a WorkCover claim lodged, when they in fact haven’t:

Example one

A person has gone to their GP after they have suffered an injury. They told their GP about the injury and how it relates to their employment.

The GP then provides that person with a certificate of capacity and the worker provides this certificate of capacity to their employer.

Example two

After suffering an injury at work, a person notes in the injury register of the employer that they suffered an injury and how it happened.

They also mention to their manager that they suffered an injury and explained how it happened.

Example three

A person lets their employer know that they suffered an injury at work. The employer pays some of the injured workers medical expenses relating to the injury.

Example four

A person who suffered a work related injury goes off on sick leave.

The employer organises a medical examination with a doctor of their choosing for a comment on work capacity and the persons ability to perform their pre injury duties at work.

So to reiterate, the above are examples where WorkCover claims have not been lodged.

In order to initiate a WorkCover claim in Victoria, you will need to have completed and lodged the WorkCover claim form.

Once the claim has been lodged and received by the insurer, it will be acknowledged.

Once the insurer has received the WorkCover claim form, they will make contact with you.

The insurer will be one of these:

  • Gallagher Bassett
  • EML
  • Allianz
  • xChanging, or;
  • One a self insurer.

They will confirm acceptance of the WorkCover claim form.

And they will advise you as to what the next steps are in relation to determining your claim.

Typically, you’ll be required to be assessed by a medical practitioner (called an independent medical examiner).

The insurer may also request medical material from your treating doctors and health practitioners, and any hospitals you may have attended for treatment of the injury.

This doesn’t happen in every WorkCover matter, but does in some where the insurer thinks that this medical material is necessary to determine your claim.

The insurer may also organise for a circumstance investigation report to be completed.

It is not likely that after a WorkCover claim has been lodged, that you do not hear from the WorkCover insurer – usually within a week of the claim being received by the insurer (sometimes a few days more). Copyright notice – this is original content from TheWorkInjurySite.com.au.

So if you do not hear from the insurer it is likely that they have not received your WorkCover claim form.

Once your claim has been determined by the insurance company, they will send you a letter confirming that they have accepted or rejected your claim.

A word on lodging a WorkCover claim

Once the WorkCover claim form has been completed by you, it will need to be lodged by you.

You can complete the claim form and then provide it to your employer, either by handing it to them or sending it to them via email or post.

They will need to complete the employer section on the claim form.

After doing so, they will then need to send the claim form off to their WorkCover insurer.

Alternatively, you can, if you know who the WorkCover insurer is, send the claim form off to them directly rather than providing it to your employer.

If you do this you should let the insurer know that you have not provided the claim form to your employer.

This is something that you might want to do if you are no longer employed by this particular employer and/or you do not wish to have any dealings with them.

Another option is to send the claim form to WorkSafe.

Before doing so, it would be a good idea to call WorkSafe up and ask them where they’d like you to send the claim form.

What if you’re not sure whether a claim has been lodged?

If you’re really not sure whether a WorkCover claim has been lodged, an easy way to find out is to contact WorkSafe.

You can call them up and provide them with some basic information and they will be able to tell you whether a claim has been lodged or not.

Alternatively, if you know who the relevant WorkCover insurer is, you can contact them and ask whether a claim has been lodged.

Conclusion

You will know whether a WorkCover claim has been lodged because you have filled out, signed and lodged the specific workers injury claim form.

If you have not completed this claim form, then it’s likely you do not have a WorkCover claim relating to your injury.

Once a WorkCover claim has been lodged and received by the relevant WorkCover insurer, you will receive confirmation from them that they have received your claim form and they are to process the claim and make a decision in relation to it.

Please keep in mind that the information contained on this page should not be considered legal advice and no content on this site should replace the need to obtain advice tailored to the specific facts of your case. The facts of a case can significantly alter the advice that can provided. This site only provides general advice. Read more here.

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To contact Michael or Peter call 1800 746 442 or email [email protected]

Written by the Work Injury Site team