WorkCover forms

Below you’ll find essential WorkCover forms you might need if you’re an injured worker in Victoria.

These forms are specifically for injured workers. If you are an employer and looking for a form, you should contact your WorkCover insurer.

What WorkCover forms are below?

Initial WorkCover claim form

You can use this form to initiate a WorkCover claim in Victoria. For the most part, this is the only way that a WorkCover claim can be initiated.

You will need to complete, sign and lodge a copy of this claim form.

You can also get a copy of these forms from WorkSafe and WorkCover insurers.

You may also be able to obtain a copy of the initial WorkCover claim form from your local post office.

WorkCover conciliation form/request for conciliation form

This is the form you can use when you want to initiate a conciliation. Conciliation is a step you can take to contest a decision made by the WorkCover insurer.

Certificate of capacity

If an injury is stopping you from working to the same extent that you were working prior to suffering the injury, you may be able to claim weekly payments from the WorkCover insurer.

In order to claim weekly payments, you’ll need to have certificates of capacity.

You can give a copy of the certificate to your doctor (or whoever is certifying you eg; a physiotherapist) and ask them to complete it. You must sign the certificate of capacity.

Impairment claim form

The impairment claim form is used to initiate a claim for impairment benefits.

This is a lump sum claim for permanent impairment.

You are able to complete and lodge this claim yourself, however generally recommend that you work with a lawyer to do so.

Reimbursement request form for travel and medical treatment

This form can be used when you want to request reimbursement from the WorkCover insurer for travel and/or medical related expenses.

General notes in relation to the forms:

• In order to access a form, click the corresponding yellow button.
• Generally, it is fine for you to complete a form electronically and sign electronically (although in some instances, WorkCover insurer’s will not accept documents signed electronically).
• Alternatively, you can print a copy of a form and sign it.

• You can also get a copy of these forms from WorkSafe and WorkCover insurers. You may also be able to obtain a copy of the initial WorkCover claim form from your local post office.

• If you need assistance completing a form or need WorkCover assistance, you can contact us via our contact page.