WorkCover claim form for Victorian WorkCover claims

On this page you’ll find a blank pdf copy of the WorkCover claim form

This is the document that you will need to complete if you want to lodge a WorkCover claim in Victoria.

This WorkCover claim form can only be used to lodge Victorian WorkCover claims.

If you wish to lodge a claim in another state or territory, this is not the correct form to use.

For most people, there are no other ways to lodge a WorkCover claim. You must complete a copy of the WorkCover claim form.

If you’ve never completed, signed and lodged a copy of this claim form before, it is likely that you do not have a WorkCover claim on foot.

If you’re not sure whether a WorkCover claim has been lodged, you can read more about that here.

Keep in mind that your doctor or medical practitioner cannot lodge a WorkCover claim on your behalf.

This is what page two (the first page that needs to be completed) of the WorkCover claim form in Victoria looks like (below):

When completing the claim form, here are a couple of important general pointers:

• It is important to be accurate. Not only will what do you write on the WorkCover claim form now be taken into account when the WorkCover insurance determining your claim, it may be relevant down the track (e.g. when you pursue common law compensation).
• There is no need to put too much information on the claim form. You just need to focus on answering the questions on the claim form adequately. You are able to add to your answers and expand on things during the claim determination process.

Lodgment of the claim form

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

• Where to send the WorkCover claim form

Here’s some further WorkCover claim resources that might be of assistance:

• When can a WorkCover claim be made?
• Time limit/s when lodging a WorkCover claim
• Lodgement of a WorkCover claim by a doctor?
• The claim determination process
• The WorkCover claim process explained
• If your WorkCover claim is rejected
• If your WorkCover claim is accepted

Please note that you can also get a copy of the claim form from the WorkSafe website and other places such as some post offices and medical clinics.

If you need assistance with the claim form or lodging a claim, you can contact us via this page.