The WorkCover claim process in Victoria

Workcover claim process 

WorkCover claim process

WorkCover Claim Process in Victoria

This chart explains the general process for lodging a WorkCover claim in Victoria, from understanding what WorkCover is, through to lodging the claim and what happens if the claim is accepted or rejected.

Important: This flowchart provides general information only. It is not legal advice and does not determine whether a WorkCover claim will be accepted. Every claim depends on its own facts, medical evidence and the insurer's assessment.
Start

What is WorkCover?

WorkCover is the Victorian workers compensation scheme. It is designed to cover the cost of benefits if employees are injured or become ill because of their work.

  • Victorian employers are required to have WorkCover insurance.
  • Full-time, part-time and casual workers can all be covered.
  • The Victorian scheme is run by WorkSafe Victoria.
WorkCover can potentially pay medical and like expenses, weekly payments, impairment benefits and, in some cases, common law damages.
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Step 1

Check the basic claiming criteria

Before lodging a claim, it is useful to consider whether the basic WorkCover criteria may be satisfied.

Connection to Victoria Your employment must be connected to Victoria in some way. This may be because you normally work in Victoria, are based in Victoria for work, or your employer's main place of business is in Victoria.
There must be an injury An injury can include a physical injury, mental injury, industrial deafness, disease, workplace stress, bullying-related condition, or an aggravation or deterioration of a pre-existing injury or disease.
You must be a worker A worker is generally someone who performs work for an employer, or agrees to perform work, at the employer's direction, instruction or request.
It does not necessarily matter if the injury occurs outside Victoria, or even outside Australia, provided the employment has the required connection to Victoria.
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Step 2

See your doctor

You should see your doctor as soon as possible after the injury or illness. This is important both for treatment and for documenting what happened.

  • Tell your doctor how the injury happened.
  • Describe your symptoms clearly.
  • Ask for treatment and any necessary referrals.
  • If you need time off work or reduced duties, ask about a certificate of capacity.
Your doctor may need to provide a medical report regarding your injury at some point during your WorkCover matter
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Step 3

Notify your employer of the injury

You should notify your employer as soon as possible regarding the injury. Ideally, this should be done in writing or recorded in the workplace injury register.

  • Use the workplace injury register if one is available.
  • You can also report the injury by email or text message.
  • Keep a copy of anything you send or complete.
  • Record the date you reported the injury.
There is a 30 day notice period for reporting an injury after becoming aware of it. However, late reporting does not automatically mean a claim cannot be accepted.
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Step 4

Complete the WorkCover claim form

The WorkCover claim form is the document used to start the claim process. What you write on the form matters, both for the initial decision and potentially later if you pursue a lump sum claim.

Read Part 2 carefully Take care when answering questions about how, when and where the injury occurred.
Explain how the injury relates to your work Be clear in your descriptions.
Disclose previous similar injuries If you have had a similar injury or condition before, whether work-related or not, it is usually better to list it.
Don't over explain You will have the opportunity to provide more information regarding your injury later on once the claim has been lodged.
Sign the form The form must be signed before it is lodged.
Leave employer lodgement details blank The employer section of the form should be completed by the employer, not the worker.
You can usually obtain the claim form from WorkSafe, some post offices, some GPs, or online.
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Step 5

Lodge the claim form

Once completed, the claim form can be given to your employer or lodged directly with WorkSafe Victoria. You should keep a copy before handing it over.

  • Take a photocopy or photo of the completed form.
  • Record the date you gave the claim form to your employer.
  • Ask for a copy once the employer has completed and signed their section.
  • If claiming weekly payments, include the date you ceased work because of the injury.
  • If claiming weekly payments, provide a certificate of capacity.
Weekly payments are not payable unless you have provided a valid certificate of capacity.
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Step 6

Employer forwards the claim

Once your employer receives the WorkCover claim form, they must forward the claim documentation to the WorkCover insurer or WorkSafe together with the medical certificate.

  • The employer must pass the claim on to the insurer.
  • The employer does not decide whether the claim is accepted or rejected.
  • The insurer is responsible for determining the claim.
  • The employer may provide their view to the insurer, but they cannot determine the claim themselves.
If you have not heard from an insurer within about four weeks of lodging your claim, you may wish to follow up with your employer or contact WorkSafe Advisory.
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Step 7

The insurer assesses the claim

The claim is assessed by a WorkSafe authorised insurer or self-insurer. This may include EML, xChanging, Gallagher Bassett, Allianz, or a self-insuring employer.

Claim form and medical material The insurer will review the claim form, medical certificate and any available medical information.
Independent medical examination The insurer may require you to attend an independent medical examination. The insurer pays for the examination.
Circumstance investigation In some claims, particularly psychological injury claims or claims with factual disputes, an investigator may speak to witnesses and prepare a report.
Refusing to attend an independent medical examination may result in the claim being rejected.
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Decision point

Insurer decision

The insurer must give written notice either accepting or rejecting the claim within the relevant decision period. In some situations, if a decision is not made in time, the claim may be deemed accepted and weekly payments may need to be made.

Common reasons for rejection include the insurer saying the injury was not caused at work, a pre-existing injury is involved, or there is a dispute about what happened.
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Accepted ✅

What happens if the claim is accepted?

If the claim is accepted, you should receive written confirmation from the insurer.

  • Medical and like expenses may be paid.
  • Weekly payments may be paid if claimed and supported by certificates of capacity.
  • Entitlements may be back paid to the date of injury.
  • You may later be able to pursue an impairment benefit.
  • You may potentially be able to pursue a common law claim if negligence caused the injury or condition.
If the claim is accepted at conciliation later, entitlements may still be back paid as if the claim had been accepted initially.
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Rejected ❌

What happens if the claim is rejected?

If the claim is rejected, that does not necessarily mean the matter is over.

  • You can ask the insurer to review the decision.
  • You can proceed to conciliation.
  • You should consider legal advice before deciding what to do.
  • If the matter does not resolve at conciliation, it may proceed to the Medical Panel or Magistrates’ Court.
  • If factual issues are involved, the Magistrates’ Court may be the required pathway.
If you cannot work while the claim is rejected, possible income options may include leave entitlements, income protection if available, or Centrelink.
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Final note

How long do you have to lodge a WorkCover claim?

There is no fixed deadline for lodging a WorkCover claim in Victoria for no-fault entitlements such as medical expenses, weekly payments and impairment benefits. However, the earlier you lodge, the better.

  • Earlier claims are often easier to support with evidence.
  • Written records such as emails, text messages or diary notes can help.
  • Medical notes from doctors or other health practitioners can be very important.
  • There is a 30 day notice period for notifying the employer of the injury.
  • Late claims can still be accepted, but evidence becomes more important.
A six year deadline may apply to common law damages claims, which is separate from the no-fault WorkCover claim process.

How to claim WorkCover

1. Let your employer know about the injury/illness/condition

You should let your employer know that you have suffered an injury related to your employment within 30 days of becoming aware of that injury.

Note however that if you don’t do so or haven’t done so, you can still claim WorkCover. Many people do not report their injuries to their employer and still successfully obtain WorkCover benefits.

You can read more about this further down the page.

2. Complete the WorkCover claim form

This is what (one page of) the WorkCover claim form looks like in Victoria.

Page 2 of the WorkCover claim form

Completing, signing and lodging this specific claim form is the only way that you are able to initiate a WorkCover claim in Victoria.

If you have not previously completed one of these forms then it is likely you do not have a WorkCover claim for a particular injury or condition.

If you’ve been told that a claim has been lodged on your behalf by someone but you haven’t signed this specific claim form, then it’s likely you do not have a claim.

It is also important to note that only you as the injured person is able to sign this claim form.

Others can lodge it on your behalf, but they cannot sign it.

Some people believe that by going to the doctor and getting a certificate of capacity that a WorkCover claim has been initiated. This is not correct and you can read more about that here.

Note: you can also lodge a WorkCover claim form online via WorkSafe’s website.

Completing the form

It is important that the WorkCover claim form be completed with care and attention. It must be accurate.

Anything that you write on the claim form could possibly be used by the WorkCover insurer to reject your claim.

For example, if your injury is a gradual process injury (that is it is occurred over a period of time rather than on a specific occasion) but you write that it occurred as a result of a specific incident, in some instances your claim may be rejected.

Likewise, if you do not for example list any previous injuries – even though you believe they may not be relevant to the claim – your claim may be rejected.

So keep this in mind.

Anything that you write on the workers injury claim form can potentially be used by the WorkCover insurer to reject your claim.

If your claim is rejected this could mean that you may need to go to conciliation which can add another month or more to the processing time during which you are not entitled to be paid weekly payments of compensation from WorkCover if you are not able to work.

This is particularly relevant for casual workers given they don’t have any leave entitlements.

It’s also particularly relevant for those that may not have an adequate amount of sick leave, annual leave or long service leave to cover the claim determination period.

If the claim fails to resolve at conciliation, and many rejected claim matters do not, if you choose to pursue the matter further you’re potentially adding six months or more in terms of delay.

Many matters where a claim has been rejected will not resolve at conciliation.

Typically what the insurer may do is offer you to settle your claim for a limited period of weekly payments and/or medical and like expenses.

And even if your claim is accepted initially, whatever you write on the claim form can potentially be used by WorkCover or their lawyers any time during the life of your claim.

3. Lodge the WorkCover claim form

Once you have adequately completed the claim form and signed it, then it must be lodged.

A WorkCover claim can be lodged by:

Most people will provide their claim form to their employer.

Some people however prefer to send it directly to the WorkCover insurer.

If there has been a breakdown in the employer/employee relationship and the WorkCover insurer is not known, then a small number of people will send the claim form directly to Worksafe.

Either way, the employer will be provided with a copy of the claim form.

They will need to complete their section on the claim form (you can see the relevant section at the end of the claim form).

They will then need to send the claim form off to the insurer for processing.

The law in Victoria says that a person must provide an employer a copy of the WorkCover claim form within 30 days of injury.

If a claim is provided outside 30 days in some instances it may be rejected on this basis.

However, the law also says that the 30 day period maybe extended if there are reasons as to why it was not reasonably practicable to lodge the claim and the reality is that a large number of WorkCover claims are lodged outside the 30 day period.

If your claim is going to be rejected, it is unlikely that it will be rejected solely on the basis of it being lodged outside the 30 day period.

Once the claim form has been lodged whether that be sent to the employer, insurer or WorkSafe, then you should record the date that this was done.

You should also receive a copy of the completed claim form once it has been signed by your employer.

4. Go through the claim determination process

What happens once the claim has been lodged is that that the insurer will acknowledge receipt of your claim.

They will send you a letter or an email.

You should receive this correspondence within a few days of your claim being received by them.

This means that if you do not receive this then potentially your has not been lodged on your behalf and you should follow things up.

Once the insurer receives the claim, they will organise an appointment for you to be medically assessed by a doctor that they choose.

This is called an independent medical examination (IME).

Once the claim has been processed and a decision has been made by the insurer, the insurer must give written notice of decision to either accept or reject the claim.

Once the claim has been processed, the insurer must give written notice of decision either accepting or rejecting the claim within 28 days after receiving it or within 28 days after receiving a medical certificate.

If your claim is accepted:

If your claim is accepted then you are entitled to receive medical expenses and if you are claiming them – and if you have provided a certificate or certificates – weekly payments.

You’re also entitled be back paid weekly payments.

The insurer will send you a letter confirming your claim has been accepted.

You may wish to proceed with an impairment lump sum claim or a common law lump sum claim down the track.

Note however that  just because your WorkCover claim has been accepted does not mean you will automatically be entitled to claim lump sum compensation.

If your claim is rejected:

If your claim is rejected then should you wish to pursue the claim further you can either ask the insurer to perform an internal review or go to conciliation.

Here’s a table summary of the steps to claiming WorkCover

Step What You Need To Do Key Points
1. Notify Your Employer Advise your employer that you have suffered an injury, illness or condition connected with your work. Although notification should generally occur within 30 days of becoming aware of the injury, many claims lodged outside this period are still successful depending on the circumstances.
2. Complete a WorkCover Claim Form Fill out, sign and submit the approved WorkCover claim form. The claim form is the document that starts a WorkCover claim. Visiting a doctor or obtaining a Certificate of Capacity does not, by itself, create a WorkCover claim.
3. Carefully Review the Information You Provide Ensure that the details recorded in the claim form are accurate and complete. Errors, omissions or inconsistencies regarding how the injury occurred, previous injuries or employment circumstances may create issues during the claim assessment process.
4. Sign the Claim Form The injured worker must personally sign the claim form. While another person may assist with lodging the form, the worker is generally the person required to sign it.
5. Lodge the Claim Form Submit the completed form to your employer, the WorkCover insurer or WorkSafe Victoria. Most workers lodge the form with their employer, who then forwards it to the insurer. A copy should be retained for your records.
6. Record Important Dates Keep a record of when the claim form was lodged and retain copies of all documents. Maintaining copies of claim documents and correspondence can assist if any dispute arises later.
7. Claim Assessment Process After receiving the claim, the insurer will investigate and assess it. The insurer may request additional information and arrange an Independent Medical Examination (IME) as part of the assessment process.
8. Receive the Insurer’s Decision The insurer must decide whether the claim will be accepted or rejected and provide written notification. A decision is generally required within 28 days of receiving the claim or relevant medical documentation.
If the Claim Is Accepted Access available WorkCover benefits. This may include payment of approved medical expenses, weekly payments (where eligibility requirements are met) and potential consideration of future lump sum entitlements.
If the Claim Is Rejected Consider challenging the decision. Options may include requesting a review of the decision or pursuing the dispute through conciliation.

Conclusion

Claiming WorkCover can be done by following the steps below:

  1. Let your employer know about the injury, illness or condition (you should do so but if you don’t you can still make a claim).
  2. Complete the WorkCover claim form.
  3. Lodge the WorkCover claim form.
  4. Go through the claim determination process.

Once the insurer has determined your claim, they will send you correspondence advising you as to whether your claim has been accepted or rejected.

If your claim is accepted you can claim medical and like expenses, weekly payments and potentially an impairment lump sum and/or a common law lump sum.

If your claim is rejected you can appeal the decision.

For the bigger picture of how the WorkCover system works overall, see How does WorkCover work?

If you want to check where your own claim currently stands, see What is your WorkCover claim status?

And for what eventually brings a claim to a close, see When does a WorkCover claim end?

For a visual version of this process, see WorkCover claims process flow chart.

 

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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.

This article was last reviewed and updated on September 8, 2026. This article was first published on May 4, 2021.

  • Michael

    This article was written by Michael who is a Victorian lawyer who practices in WorkCover and personal injury matters. He has 20 years of experience in personal injury matters. This article was written in collaboration with his colleague Peter. The Work Injury Site is where they publish WorkCover and work injury related information. Both Michael and Peter have a law firm that assists people across Victoria with their WorkCover and personal injury matters. You can read more about Michael here.

  • Peter

    This article was written by Peter who is a Victorian lawyer who practices in WorkCover and personal injury matters. This article was written in conjunction with his colleague Michael. The Work Injury Site is where they publish WorkCover and work injury related information. Both Peter and Michael have a law firm that assists people across Victoria with their WorkCover and personal injury matters. You can read more about Peter here.

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