WorkCover claims process flow chart

Below is a WorkCover claims process flow chart that outlines the WorkCover process in Victoria.

WorkCover claim process

Flowchart of the WorkCover Claim Process in Victoria

This flowchart shows the broader WorkCover claim journey in Victoria, from injury and claim lodgement through to accepted claim entitlements, rejected claim pathways, weekly payments, medical and like expenses, impairment benefits and common law damages.

Important: This flowchart provides general information only. It is not legal advice and does not determine whether a WorkCover claim, impairment claim or common law claim will succeed. Every matter depends on its own facts, medical evidence and the decisions made by the insurer, WorkSafe, the Workplace Injury Commission, the Medical Panel or a Court.
Claim lodgement and assessment
Accepted claim entitlements
Disputes and conciliation
Impairment benefit pathway
Common law pathway
Phase 1

Injury, medical treatment and initial claim lodgement

The WorkCover claim process usually begins when a worker suffers an injury, illness or condition connected with their employment.

Start

Work-related injury or illness

A WorkCover claim may relate to a physical injury, psychological injury, disease, industrial deafness, workplace stress condition, bullying-related condition, or an aggravation or deterioration of a pre-existing condition.

Connection to VictoriaThe employment must have a sufficient connection with Victoria.
Worker statusThe person must generally be a worker or employee within the scheme.
Injury or conditionThere needs to be an injury, illness, disease or aggravation capable of being claimed.
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Step 1

Get treatment

A doctor can treat your injury, make referrals and, if needed, issue a certificate of capacity.

  • Explain how the injury happened.
  • Describe your symptoms and restrictions clearly.
  • Ask about treatment and referrals.
  • If you need time off work or modified duties, ask about a certificate of capacity.
Weekly payments generally require valid certificates of capacity.
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Step 2

Notify the employer

Notify the employer of the injury as soon as possible. Ideally this should be done in writing or recorded in the workplace injury register.

  • Use the workplace injury register if available.
  • Email or text message can help create a written record.
  • Keep copies of anything sent or completed.
  • Record the date the injury was reported.
There is a 30 day notice period for notifying an employer after becoming aware of an injury, although late reporting does not automatically mean a claim cannot be accepted.
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Step 3

Complete the WorkCover claim form

The claim form commences the formal WorkCover claim process. What is written on the form can matter, both for the initial liability decision and potentially later in the claim.

Explain the injuryDescribe how, when and where it happened.
Link it to workMake the connection between the injury and employment clear.
List prior similar injuriesDisclose relevant previous injuries or similar conditions.
Do not over-explainMore information can usually be provided after lodgement.
Sign the formThe worker section must be signed before lodgement.
Employer sectionLeave the employer lodgement details for the employer to complete.
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Step 4

Lodge the claim form

Once completed, the claim form can be given to the employer or lodged directly with WorkSafe Victoria. Keep a copy before lodging it.

  • Keep a photo or copy of the completed claim form.
  • Record the date the form was provided.
  • If claiming weekly payments, include the date you stopped work because of the injury.
  • If claiming weekly payments, attach a valid certificate of capacity.
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Step 5

Employer forwards the claim to the insurer

The employer forwards the claim documentation to the WorkCover insurer or WorkSafe. The employer may provide information, but the insurer determines whether the claim is accepted or rejected.

The employer does not decide whether a WorkCover claim is accepted or rejected.
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Step 6

Insurer assesses the claim

A WorkSafe authorised insurer or self-insurer assesses the claim. The assessment may include a review of the claim form, certificates, medical material, independent medical examinations and factual investigations.

Medical materialClaim form, certificates, treatment records and reports may be reviewed.
Independent medical examThe insurer may arrange an IME to obtain a medical opinion.
Circumstance investigationSome claims involve interviews, witness evidence or factual investigation.
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Decision point

Insurer decision: accepted or rejected?

The insurer must provide a decision accepting or rejecting the claim within the relevant decision period. The decision determines the next pathway.

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Accepted claim ✅

Accepted WorkCover claim

If the claim is accepted, the worker may be entitled to claim medical and like expenses, weekly payments if capacity for work is affected, and later lump sum pathways such as impairment benefits and potentially common law damages.

  • Medical and like expenses may be payable.
  • Weekly payments may be payable if supported by certificates of capacity.
  • Entitlements may be back paid depending on the circumstances.
  • Later lump sum claim pathways may become relevant.
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Rejected claim ❌

Rejected WorkCover claim

If a claim is rejected, the matter is not necessarily over. The worker may challenge the decision, usually through conciliation.

  • Ask the insurer to review the decision.
  • Lodge a conciliation request.
  • Consider legal advice before deciding what to do.
  • If unresolved, the dispute may proceed to the Medical Panel or Magistrates' Court depending on the issues.
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Dispute pathway

If the claim, treatment or weekly payments are disputed

Disputes about liability, weekly payments, medical expenses or treatment decisions often proceed to conciliation. If the dispute does not resolve, the next pathway depends on the nature of the issue.

Conciliation

Workplace Injury Commission conciliation

Conciliation is commonly used to dispute a rejected claim, refused medical expense, weekly payment termination, weekly payment reduction or calculation issue.

Medical issueMay proceed to the Medical Panel if the dispute is primarily medical.
Factual or legal issueMay proceed to the Magistrates' Court if the dispute turns on factual or legal matters.
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Accepted claim entitlements

What can an accepted WorkCover claim lead to?

Once an initial WorkCover claim has been accepted, four major entitlement pathways may become relevant: medical and like expenses, weekly payments, impairment benefits and common law damages.

🏥

Medical and like expenses

If the WorkCover claim is accepted, the insurer is generally liable to pay the reasonable cost of medical and like services related to the injury.

  • Medical, hospital, ambulance and chemist expenses.
  • Physiotherapy, osteopathy, chiropractic and other treatment.
  • Psychology or counselling where applicable.
  • Travel expenses related to treatment or medical examinations.
  • Home or vehicle modifications in appropriate cases.
  • Household help, rehabilitation and aids in some circumstances.
If the insurer refuses to pay for a medical expense, the decision can usually be disputed through conciliation.
💵

Weekly payments

Weekly payments are income payments paid where an accepted work-related injury affects a worker's ability to work.

  • A certificate of capacity is generally required.
  • Payments are based on pre-injury average weekly earnings, commonly called PIAWE.
  • The first 13 weeks are generally paid at a higher percentage than later weeks.
  • From weeks 14 to 130, a different rate applies.
  • At 130 weeks, the eligibility test becomes more difficult.
  • Weekly payment terminations or reductions can be disputed.
If weekly payments are reduced or terminated and you disagree, conciliation is commonly used to challenge the decision.
📋

Impairment benefit claim

An impairment benefit is a lump sum claim for permanent impairment resulting from a work-related injury or illness.

  • The injury generally needs to be stable before the claim is made.
  • The worker completes an impairment benefit claim form.
  • The insurer arranges independent medical assessments.
  • Impairment is assessed as a whole person impairment percentage.
  • If the relevant threshold is reached, an offer is issued.
  • If the assessment is disputed, the matter may proceed to the Medical Panel.
An impairment benefit generally does not affect weekly payments or medical and like expenses, but may be taken into account in a common law claim.
⚖️

Common law

A common law claim is a separate lump sum damages claim that may be available where there is a serious injury and negligence can be established.

  • A serious injury application is prepared and lodged.
  • Medical material, affidavits and income documents may be included.
  • A law firm appointed by WorkSafe assesses the application.
  • The decision period is generally 120 days.
  • If serious injury is granted, the matter proceeds to a settlement conference.
  • If not resolved, statutory offers, mediation and court proceedings may follow.
Common law claims are complex and generally require legal representation.
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Weekly payments detail

Weekly payments pathway

Weekly payments depend on work capacity, certificates of capacity and the stage of the weekly payment period.

Certificate of capacityProvide valid certificates to support incapacity or reduced capacity.
→
First 13 weeksPayments are calculated by reference to PIAWE at the early payment rate.
→
Weeks 14 to 130Payments continue if incapacity remains, generally at a lower percentage.
→
130 week reviewThe test becomes more difficult. Ongoing payments depend on meeting the post-130 week requirements.
Weekly payment disputes

If weekly payments are reduced or terminated

If the insurer reduces or terminates weekly payments and the worker disagrees, the worker can query the decision, seek reasons and generally pursue the dispute to conciliation.

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Medical expenses detail

Medical and like expenses pathway

Medical and like expenses focus on reasonable treatment connected to the accepted work-related injury.

Medical expenses

Treatment, reimbursement and disputes

Choose providersWorkers may generally choose their medical and like service providers.
Claim reimbursementReceipts can be submitted to the insurer with the worker's name and claim number.
Direct billingSome providers may bill the insurer directly if provided with the claim number.
If the insurer refuses to fund treatment, the decision can usually be challenged at conciliation. If unresolved, the dispute may go to the Medical Panel or Magistrates' Court.
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Impairment benefit pathway

Permanent impairment lump sum claim

An impairment benefit claim is generally pursued after the injury has stabilised and permanent impairment can be assessed.

Impairment claim process

Impairment benefit claim flow

Injury stabilisesThe injury should not be materially improving or worsening.
Claim form lodgedAll relevant injuries and consequences should be listed.
IME assessmentThe insurer arranges assessment by trained medical examiners.
WPI ratingWhole person impairment is assessed and combined where relevant.
Offer or disputeThe insurer issues an offer, or the assessment may be disputed.
Threshold reached ✅

Offer issued

If the required threshold is reached, the insurer issues a notice and offer. If accepted, the impairment benefit claim is finalised and payment usually follows.

Disputed or threshold not reached

Medical Panel pathway

If the worker disputes the assessment, the matter may proceed to the Medical Panel. The panel assesses the worker and issues an opinion.

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Common law pathway

Serious injury and common law

A common law claim is separate from the initial no-fault WorkCover claim. It generally requires a serious injury and negligence.

Serious injury application

Prepare and lodge the serious injury application

Medical materialTreating reports, IME reports and other medical evidence.
Affidavit materialEvidence about the before and after impact of the injury.
Income materialTax returns and other income-related documents where relevant.
Claim documentThe formal serious injury claim document.
Medical authorityAuthority allowing relevant medical records to be requested.
LodgementThe application is lodged with the Victorian WorkCover Authority pathway.
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120 day decision

Is serious injury accepted?

After lodgement, lawyers appointed for the WorkCover side assess the serious injury application and decide whether to grant or deny a serious injury certificate.

Yes ✅

Serious injury certificate granted

  • The matter proceeds to a settlement conference.
  • If resolved, compensation is paid and the common law matter is finalised.
  • If not resolved, statutory offer and counter offer steps usually follow.
No ❌

Serious injury denied

  • The worker may issue proceedings in the County Court.
  • A Judge decides whether the worker has a serious injury.
  • If successful, the matter returns to the common law settlement pathway.
If common law matter does not resolve early

Statutory offer, mediation and court

Settlement conferenceThe parties attempt to resolve the common law matter.
Statutory offerThe WorkCover side makes a formal written offer.
Counter offerThe worker responds with a statutory counter offer.
Writ issuedCourt proceedings are issued if the matter does not resolve.
MediationThe parties usually attempt resolution before hearing.
Hearing or settlementThe matter resolves by agreement or proceeds to hearing.
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Final summary

How the WorkCover claim process fits together

The initial claim is the entry point into the WorkCover system. If accepted, it can lead to medical expenses and weekly payments. Later, depending on stability, permanent impairment and negligence issues, the worker may also consider an impairment benefit claim or common law damages claim.

Initial claimEstablishes liability for the work-related injury or condition.
Medical expensesFocus on reasonable treatment and like services connected to the injury.
Weekly paymentsFocus on incapacity for work and certificates of capacity.
Impairment benefitsFocus on permanent impairment after the injury stabilises.
Common lawFocus on serious injury, negligence and damages.
DisputesMay involve conciliation, Medical Panel, Magistrates' Court or other court proceedings.

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 please visit the contact page.

Last updated on August 17, 2026 by The Work Injury Site

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