WorkCover and the first 10 days

Once your claim has been accepted, the WorkCover insurer should contact you to confirm this.

If you have any accounts or receipts relating to medical treatment that you had prior to the claim being accepted, you should send these off to the insurer (if you haven’t already done so).

You’ll likely be entitled to claim the cost of any medical expenses incurred in relation to the injury, as well as medical expenses ongoing.

If your claim also involves a claim for weekly payments, the WorkCover insurer should confirm your pre injury average weekly earnings amount.

If arrears of weekly payments are to be paid to you, the insurer should discuss this with you.

Once your WorkCover claim has been accepted your employer may, in certain instances, be responsible for payment of the first 10 days of incapacity payments as well as the first $763 (indexed annually) of medical and like expenses relating to the treatment of your injury.

There is however an option on WorkCover insurance which some employers take out which results in them not having to pay for the first 10 days. In these instances, the first 10 days are payable by the WorkCover insurer.

They will also not have to pay for the first 10 days if the injury is a mental injury where a person is entitled to provisional payments.

You’ll receive a claim acceptance letter from the WorkCover insurer

Once your claim has been accepted you should receive a claim acceptance letter from the WorkCover insurer.

A person from the WorkCover insurer may also call you and advise you that your claim has been accepted.

Weekly payments first 10 days

If your WorkCover claim involves a claim for weekly payments, you should expect the WorkCover insurer to advise you of your pre injury average weekly earnings amount.

This is the figure that your weekly payments are based on.

If any arrears of weekly payments are to be paid to you, you should expect someone from the WorkCover insurer to discuss this with you.

Don’t expect to be paid any arrears of weekly payments in the first ten days after your claim has been accepted, however.

The payment of arrears of weekly payments after claim acceptance can sometimes take the insurer a bit of time.

You should ensure you have provided any relevant certificates of capacity to the WorkCover insurer.

If you are certified as having a modified work capacity, or no work capacity, the first 10 days of incapacity will need to be paid for by your employer.

Your employer will not need to cover the first 10 days if the injury you are claiming is a mental injury where you would be entitled to provisional payments, or they have elected to have the WorkCover insurer cover the first 10 days.

The first 10 days of incapacity are the first 10 working days that you would’ve worked if you had not been injured.

What if you are working reduced hours but still working?

In this instance, if you are partially incapacitated, and still working, but not working your pre-injury hours, any day that you are working reduced hours will count towards the 10 days of incapacity.

For example, if a normal work day would involve you working eight hours a day, but following the injury you are only able to work four hours a day, every four hour day would count as a day in terms of the 10 days of incapacity.

If there is a delay in relation to payment of the first 10 days of incapacity from your employer, you should follow up your employer or the WorkCover insurer.

You do not need to ask the employer to make payment to you. The insurer will in most instances advise the employer of this requirement.

The employer is required to notify the WorkCover insurer of payments made to you for the first 10 days of incapacity.

After they have paid the first 10 days of incapacity, if you are impacted in terms of your work capacity moving forward, either on a partial basis, or on a complete basis, it is then the responsibility of the WorkCover insurer to pay you weekly payments.

Medical and like expenses paid

Once your claim has been accepted, you’ll be entitled to the payment of medical and like expenses.

This includes reimbursement or payment for any (reasonable) out of pocket expenses relating to medical treatment obtained prior to the claim being accepted.

It also includes ongoing payment of medical and like expenses.

Your employer is required to pay for the first $763 (indexed annually) of medical expenses.

What you need to do is provide any medical expenses to either your employer or the WorkCover insurer to ensure that the first $763 is paid.

After this, just like with the payment of weekly payments, the responsibility for payment of your medical like expenses moves to the WorkCover insurer.

It’s easier sometimes just to send all of your invoices and accounts directly to the insurer, and then the insurer can invoice the employer to make a single payment in lieu of having to pay individual accounts as part of their employer excess.

Conclusion

In the first ten days after your claim has been accepted, you should receive notification of your claim being accepted in writing from the insurer.

You’ll be entitled to claim medical expenses – both arrears of medical expenses and expenses ongoing. The employer (in some instances) is required to pay the first $763 of medical and like expenses with the insurer responsible for paying your medical and like expenses beyond that amount.

You may also have an entitlement to weekly payments – again both arrears and ongoing. The employer (in some instances) is required to cover the first 10 days of incapacity after which any weekly payments are to be paid for by the WorkCover insurer.