WorkCover claim accepted

Workcover claim accepted

Once your WorkCover claim has been accepted in Victoria, that will entitle you to two things only. 

That is, the payment of weekly payments of compensation if your ability to work has been impacted, and the payment of reasonable medical and like expenses.

There are other entitlements under the WorkCover scheme, but you are not automatically entitled to access these simply because your initial WorkCover claim has been accepted.

This page will explore the above in detail.

Is your claim actually accepted?

This might seem like an obvious point to address, but it is worthwhile going over.

Many people mistakenly believe that their WorkCover claim has been accepted when it has not.

This is understandably so because lots of people have never had anything to do with the WorkCover system before.

For example, some people might go to the doctor after suffering an injury and the doctor might provide them with a certificate of capacity which they then provide to their employer.

They might believe that have an accepted WorkCover claim because of this.

Similarly, a person might mention to their employer that they have suffered an injury and they therefore assume that this is how a WorkCover claim is lodged and accepted.

A WorkCover claim is only lodged if you have completed the required work cover claim form document and this has been lodged.

That is, you have received confirmation from a WorkCover insurer that your claim is being processed.

The WorkCover claim is only accepted if you have received confirmation from the WorkCover insurer that your claim has been accepted.

You should receive a letter from them confirming that your claim has been accepted and you should be provided with a WorkCover claim number which is a very important number which you should ensure to keep a note of it.

You are entitled to two things once your claim has been accepted

As referred to above, once your WorkCover claim has been accepted you are only entitled to two things.

The first is to the payment of reasonable medical and like expenses.

You can read about medical and like expenses in detail here.

Medical and like expenses the medical and like expenses paid for by the WorkCover insurer are wide ranging.

In general, they will pay for things such as GP attendances, physiotherapy, chiropractic treatment, surgery and post surgical care, travel and accommodation.

The second thing that you may be entitled to as the payment of weekly payments.

You’re entitled to claim weekly payments if your ability to work is impacted as a consequence of a work related injury or illness or condition.

So if you can’t work to the same extent that you did previously and you need some time off work, or you can’t work at all, then you’re entitled to claim weekly payments from the WorkCover insurer.

You can read about weekly payments in more detail here.

In a nutshell however, you are entitled to be paid at the rate of 95% of your pre-injury average weekly earnings for the first 13 weeks and thereafter you’re entitled to be paid at the rate of 80% up until 130 weeks.

Some people are entitled to pay be paid beyond 130 weeks if they can show they’ve got no work capacity and this is likely continue indefinitely.

If the person was receiving overtime or shift allowances prior to the injury occurring then they are entitled to have these factored into the pre injury average weekly earnings calculation for the first 52 weeks.

In order to claim weekly payments you will need to obtain certificates of capacity from a medical practitioner or health practitioner and ensure that you continue to provide certificates of capacity during the period where you’re trying to claim weekly payments.

Potential for top up pay

You can read about how you might be entitled to top up/make up payments under the WorkCover scheme here.

The thing to keep in mind is that some people are entitled to top up payments because it is specified in their EBA or other agreement.

Top up payments can obviously pay the difference between what you are getting on WorkCover (whether that be at the 95% or 80%) and what you would have been receiving had you not suffered your injury.

Employment entitlements once your WorkCover claim has been accepted

You can read about the employment entitlements and WorkCover here.

Your annual leave will continue to accrue while you’re on WorkCover.

Your long service leave also continues to accrue.

Sick leave however will not accrue while you’re on WorkCover payments. You can be on WorkCover and accrue sick leave however but sick leave will accrue only based on the hours worked.

While on WorkCover payments you are entitled to be paid superannuation contributions after 52 weeks.

The remaining WorkCover entitlements

As mentioned above, just because you have had a WorkCover claim accepted does not mean that you are entitled automatically to all of the potential entitlements under the WorkCover scheme.

An accepted WorkCover claim just entitles you to the payment of medical expenses and weekly payments.

There are, generally speaking, two further entitlements.

The first is an impairment benefit lump sum and the second is a common law claim for damages.

Impairment benefits

You can read about impairment benefits here.

The impairment lump sum claim is a claim that a person is entitled to pursue if they have suffered permanent impairment related to their employment.

You can claim for physical injuries, psychological injuries, and other diseases and conditions.

A person must wait until all of the injuries, illnesses and conditions that they are trying to claim have stabilised. You can read about stabilisation here.

Generally speaking, this is a minimum of 12 months from when the injury occurred.

In order to initiate an impairment claim, you need to complete and lodge a specific impairment claim form.

You will then go through a process whereby any injuries are you are claiming for need to be assessed by specialist doctors and your whole person impairment rating will need to be determined.

Common law claim

You can read about common law claims here.

Common law claims are different to impairment claims and again in order to issue a common law claim, like an impairment claim you need to specifically apply for it.

Again, like an impairment claim, your injury needs to be stablised.

This is because what you were getting compensated for is any permanent impact an injury has on your life.

Common law claims are usually pursued after a person has gone through the impairment claim process and finalised their impairment claim.

And it doesn’t really matter whether a person succeeded in obtaining an impairment benefit lump sum.

A person can fail to obtain an impairment lump sum and still succeed in a common law claim.

The first step to initiate a common law claim is for a serious injury application to be lodged. 

You must obtain a serious injury certificate.

The two things that you must prove in relation to a common law claim to succeed is that you have a serious injury and that there was negligence on behalf of another party which contributed to your injury.

If you’re successful you can be compensated for pain and suffering and potentially economic loss.

If the Insurer makes a decision you disagree with

Keep in mind that during the WorkCover process, if the insurer makes decision in relation to weekly payments, medical expenses and in very limited situations an impairment benefit – which you disagree with – you can appeal that decision to conciliation.

You can read about conciliation here.

If the matter fails resolve it conciliation then there are options beyond that.

What are the timeframes in a WorkCover matter?

We’ve written about WorkCover claims and timeframes before.

You should read this page which will explain expected timeframes.

What about once everything has been finalised?

Once your claim has been finalised, there’s a few things you should be aware of. This page will assist you.

Conclusion

The first thing you need to ensure is that that your WorkCover claim has actually been accepted. Many people believe they have an accepted WorkCover claim when in fact they don’t.

If your WorkCover claim has actually been accepted, then you’re entitled to two things.

The first is having the cost of reasonable medical and like expenses paid.

And the second is weekly payments.

In general there are two further entitlements under the WorkCover scheme. The first is an impairment claim and the second is a common law claim for damages.

Just because you have an accepted WorkCover claim does not mean that you’re entitled to these two lump sum‘s. If you wish to claim either or both of them, then you’ll need to make specific applications over and above an initial WorkCover claim.

If the insurer makes a decision in relation to the weekly payments, medical expenses and in limited cases an impairment claim, you can appeal that decision by the conciliation process in first instance.

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.

Sidebar graphic of WorkCover benefits guide

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

Written by the Work Injury Site team