14 things to consider before making a claim for workers compensation in Victoria

Things to consider before making a workers compensation claim graphic

Before you lodge a WorkCover claim, there’s a number of things that you should consider.

If you’re wondering how to make a WorkCover claim, you can visit this page.

Is a WorkCover claim right for you?

Sometimes, you shouldn’t lodge a WorkCover claim.

For example, if you have an injury that is likely to be a very short term one where you might not need any medical treatment, or you might not need any time off work.

In these circumstances, you need to ask yourself whether you want to go through the WorkCover process for no gain.

An initial WorkCover claim will compensate you for medical and like expenses and weekly payments. If you don’t need either of these things, then a WorkCover claim isn’t going to be much help for you.

But what if I don’t need treatment or time off work now, but I don’t know how the injury is going to progress and how things might be over the next few months?

Well, yes, you can lodge a WorkCover claim now, even if you might not utilise it.

Or, you can make sure the injury is noted by reporting it to your employer and perhaps visiting a doctor or other health practitioner who can also record details of the injury. This way if down the track you want to lodge a claim, there’s documented evidence about it.

Understand what you can claim

Before lodging a WorkCover claim you should understand what benefits you can get under a WorkCover claim.

In general, you can claim the payment of medical and like expenses, weekly payments for lost income as a consequence of your injury,.

You also able to pursue an impairment benefit if you have a permanent impairment. Finally in some cases where your injury was caused by someone else negligence, you can pursue a common law claim for damages.

Via a common law claim for damages you can pursue compensation for pain and suffering and in some cases, economic loss.

Will a WorkCover claim impact your current employment?

It’d be nice to say with certainty that a WorkCover claim won’t impact your employment.

Employers are not allowed to discriminate against people that have lodged WorkCover claims.

But, in reality, we know it happens sometimes.

Yes, there are laws in place to protect people that have lodged WorkCover claims from being discriminated.

But if you lodge a WorkCover claim and you get treated poorly because of it, you need to actually understand the legal avenues you’ve got available to you to do something about it. Or you need to have a lawyer that does.

And doing something about it can come at considerable time and expense. And lawyers don’t work for free.

So yes employers are not able to discriminate against people who have lunch WorkCover claims but the reality is that it sometimes does happen.

And you need to be prepared for that to potentially happen.

Some employers view Workcover with disdain, while others see it for what it is – just someone pursuing their lawful entitlements.

Will a WorkCover claim impact your future employment prospects?

If you are applying for a new job in the future, realise that sometimes employers will ask you about any previous WorkCover claims, and other times they will not.

If you are asked, you should declare that you’ve had a previous WorkCover claim because if you aggravate the injury, your entitlement to compensation may be impacted if you do not reveal that you’ve had a previous claim.

As mentioned above, employers can’t discriminate against people that lodge WorkCover claims. However, in reality it does happen.

When you see your doctor after the injury

When you see your doctor after the injury, you should make sure that you specify exactly how the injury happened, when it happened and what symptoms you are experiencing.

This is not only because it’s important to allow the doctor to treat you, but also because the doctors notes may be used in the future when considering whether or not your claim should be accepted.

Choose your words carefully and be accurate.

Report the injury to your employer

If you’ve been injured at work, you should ensure to report the injury to your employer as soon as you can.

Your employer should have an injury register book and you should ensure to make a note of injury in the book.

Alternatively you can send an email or a text message to your employer.

Either way putting it in writing is certainly important, as is keeping a copy for your own records.

If you don’t want to lodge a WorkCover claim straight away, then this report of your injury, along with any medical material, could be very important in determining whether your claim will be accepted.

The WorkCover insurer pays for your benefits

If your claim is accepted, benefits will paid for by the insurance company not the employer.

This is all benefits: weekly payments, medical and like expenses, impairment benefit and common law claim damages.

In Victoria, employers are required to have WorkCover insurance. This means that if any of their employees are injured, the insurance company (WorkCover) will pay for any benefits.

This is the case whether the employer was at fault or not for your injuries because Victoria has what’s called a no fault system.

Whether to lodge the claim now or wait?

Generally speaking, the sooner that you lodge your WorkCover claim, the more likely it is to go through and be accepted without any issues.

There are time limits that apply to making a WorkCover claim which are discussed here.

However, WorkCover claims are lodged months or sometimes years after the injury occurred – and are accepted.

The most important thing is that there is evidence supporting the fact that you suffered an injury at work. And the more evidence the better.

This evidence can come from the report of the injury that you made to your employer. It could also come from from The notes of attendance from your general practitioner or other medical practitioners.

The bottom line is that you do not need to lodge a WorkCover claim until you feel ready to do so.

And there can be valid reasons for waiting to lodge a WorkCover claim. One common reason is you may want to wait and see how your injury progresses.

To be clear – it’s always best to lodge the claim as soon as possible. But it isn’t critical.

Once you lodge a claim, know that it will be investigated

Keep in mind that once you lodge a WorkCover claim, the WorkCover insurer has the responsibility of assessing the claim.

This involves sending you to an independent medical examiner who will provide comment on the nature of your injury or condition and its connection to work.

In some cases, usually those involving psychological injury or matters where there are factual circumstances that may be complex, the insurer may organise a circumstance investigation report which involves an investigator speaking to you and other key witnesses and putting together a report on the circumstances relating to your injury or condition.

Keep in mind that once you lodge a WorkCover claim, you will have to attend the independent medical examination which generally occurs in Melbourne. This is not such a big deal if you live in Melbourne, but can be a nuisance for those in regional areas.

You will need to attend the independent medical exam, otherwise there’s a decent chance your claim will be rejected.

Also keep in mind that you do not necessarily need to speak to the circumstance investigator but in some cases by not speaking to the investigator this can increase the chances of your claim being rejected.

If you have an accepted WorkCover claim, you from time to time will need to be assessed

Once your claim is accepted from time to time the insurance company may wish to send you to independent medical examinations.

The reasons for the insurer organising further independent medical examinations are varied you can find out more here.

A couple of the common reasons are:

  • The insurer wants to determine whether to continue to pay for a medical expense
  • The insurer wants a doctor to comment on your work capacity

Keep in mind that most of the time if you do not attend an independent medical examination the insurer can seek to impact your benefits.

But they need to occur at reasonable intervals. They can’t have you assessed and then a couple of months later, organise for you to be assessed again because they don’t like the initial assessment.

A good rule of thumb is that you should consider that you’ll be assessed once a year or so. Sometimes more, sometimes less, depending upon the nature and circumstances of your injury.

You will need certificates of capacity

If you have an accepted WorkCover claim and wish to claim weekly payments for lost income, you will need to attend your general practitioner or other health practitioner for certificates of capacity at regular intervals.

The certificates generally are obtained every 28 days and must be obtained if you are to continue to be paid.

Sometimes certificates can be for 3 month intervals but you’ll need to get permission from the insurer first before obtaining certificates that run for three months.

Know that there’s a chance your claim could be rejected

Before lodging your WorkCover claim you should consider the fact that there is a chance that your WorkCover claim may be rejected.

If it is rejected, you need to consider whether you would appeal the decision to reject your claim or whether you would drop the claim and not pursue it.

If your claim is rejected and you wish to continue to pursue the matter, you must first do so via conciliation.

Seeking legal advice prior to lodgement of a WorkCover claim can help you answer how likely it is that your claim will be rejected.

This page details what to do if your claim is rejected.

There is a small chance that your matter may end up in court

Most WorkCover matters, whether they relate to your no fault benefits (medical and like expenses, weekly payments or impairment benefit) or common law damages, do not end up in court. Keep this in mind.

Take your time when completing the WorkCover claim

You should read each question carefully on the claim form and think about your answers.

Your answers may result in your claim being rejected.

Even if your claim is accepted, anything you write on the claim form can also be used down the track when you may bring a lump sum claim.

When you answer how the accident occurred, you do not need to go into a bunch of details and over explain things. Keep your answers clear and straightforward.

There is a question on the claim form that many people seem to be confused by. The question is have you previously had another injury or conditional or personal injury claim that relates to this injury or condition?

This is asking whether you’ve had a similar injury whether it’s related to work or not. If you are in doubt, it is best to answer yes and list any old injuries that could be similar.

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.

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

Written by the Work Injury Site team