How does WorkCover work?
WorkCover is a type of insurance that provides certain benefits to injured workers in the event they suffer an injury, illness or condition related to their employment. This injury, illness or condition could occur over a period of time, or it could occur in a single incident.
This page will look at how WorkCover works from the perspective of an injured worker.
Table of Contents
WorkCover is insurance for employers
All Victorian employers are required to have WorkCover insurance.
So if you, as a worker, suffer an injury, condition or illness related to your employment, then you may be able to obtain benefits under the WorkCover scheme.
These benefits are;
- Payment of medical and like expenses
- Weekly payments.
- Impairment benefit lump sum.
- Common law lump sum.
Initiated with WorkCover claim form
A WorkCover claim is initiated by the completion of the WorkCover claim form.
This is a specific form that must be completed by you if you wish to lodge a claim.
If you have not completed and lodged the specific WorkCover claim form, it’s very likely that you have not initiated a WorkCover claim.
This is what the WorkCover claim form looks like (note: this is page two of the form):
Your doctor can’t initiate a WorkCover claim on your behalf. Neither can your employer.
And obtaining a certificate of capacity from your doctor does not by itself initiate a WorkCover claim. Even if that certificate of capacity has been provided to your employer.
Once the WorkCover claim has been lodged
As mentioned above, you initiate a WorkCover claim by completing and lodging the WorkCover claim form.
Once you’ve done so, the claim will then be determined by a WorkCover insurer. In Victoria, this will be one of: Allianz, Gallagher Bassett, DXC/xChanging.
(Note: under the Victorian WorkCover scheme, some larger employers handle their own WorkCover claims. They’re known as self insurers. If you work for one of these employers, your claim will be managed by them and not one of the insurer’s referred to above).
The insurer will need to make a decisions as to whether they accept or reject the claim.
They’ll usually organise an appointment for you to be assessed by an independent medical examiner (IME). They arrange the appointment and pay any associated costs – you don’t need to pay any costs related to the appointment.
They’ll sometimes also organise a circumstance investigation report. This involves arranging for someone to speak to you and any other relevant people, and attend your workplace and put together a report outlining the relevant circumstances for the insurer.
If your claim gets accepted
If your WorkCover claim gets accepted you’re entitled initially to the payment of medical expenses, and if your ability to work has been impacted, and you’ve obtained and provided a certificate of capacity to the insurer, weekly payments.
The range of medical and like expenses that the insurer will pay for once your claim has been accepted is quite broad.
If your ability to work has been impacted, you should be able to claim weekly payments under your WorkCover claim from the insurer. You’ll need to obtain certificates of capacity and submit these to the insurer and/or the employer.
Generally speaking, you’ll be entitled to 130 weeks of weekly payments – sometimes more if you don’t have a work capacity and this is likely to continue.
Once your injury has stabilised and it’s not getting any better, not getting any worse, if you are left with a permanent impairment, you may be entitled to claim an impairment lump sum claim which is based on your whole person impairment rating.
You may also be able to claim a common law lump sum claim.
If your claim is initially rejected
If your claim is initially rejected, then you have the option of contesting the decision.
The initial steps to contest a decision can involve asking the insurer to perform an informal review of the decision and/or pursuing the matter to conciliation via the Workplace Injury Commission.
If the matter fails to resolve at Conciliation then there are options open to you to continue pursuing the matter.
Who pays for WorkCover benefits?
Your WorkCover benefits are paid for by the WorkCover insurer.
In Victoria employers are required to have WorkCover insurance and to pay an annual fee to have that insurance.
Any benefits that you receive, whether that be in the form of payment for medical expenses or weekly payments or lump sum compensation is paid for by the WorkCover insurer, not the employer.
The employer, however, in some instances, does have an obligation to pay you for the first 10 days after the claim has been accepted.
Fault and no fault
Victoria has a hybrid fault and no fault system. This means that part of the compensation system is fault based while the other part is no fault based.
It means that you can claim some benefits even if no one else (such as your employer) was a fault for your injury.
The benefits that you can claim without there being fault are; medical expenses, weekly payments, impairment lump sum.
There is one fault based entitlement, which means that in order to claim this entitlement, you need to show that your employer or a third-party was at fault for your injury. This is a common law lump sum claim.
What impact will a WorkCover claim have on employment entitlements?
You can read about the impact that WorkCover has on employment entitlements here.
Do you have to lodge a WorkCover claim if you’re injured?
No, you do not need to lodge a WorkCover claim in Victoria if you do not wish to.
When determining whether or lodge a claim, you should consider the benefits that a WorkCover claim can give you.
Conclusion
WorkCover is insurance that Victorian employers are required to have. If you as a worker suffer an injury, condition or illness related to your employment then you may have an entitlement to benefits.
WorkCover benefits include: medical and like expenses, weekly payments, impairment lump sum and common law lump sum.
A WorkCover claim is initiated by the completion of a WorkCover claim form. If you haven’t completed and lodged this form, it’s likely you haven’t initiated a claim.
