WorkCover (Vic) questions and answers.

Workcover questions and answers graphic

Here’s a list of common asked WorkCover questions with answers.

When to report a work related injury?

If you suffer an injury, you should report the injury as soon as possible. It should be reported to your employer within 30 days of it occurring.

Sometimes a delay in reporting your injury, or failing to report your injury at all, can hurt your chances of having a WorkCover claim accepted down the track.

But…

Some people don’t want to report their injury to their employer for various reasons. They might be afraid that it could impact their job, or they don’t want to get one of their mates in trouble.

If this is the case with you and you don’t feel ready to report your injury, then we would suggest visiting at least one of your medical practitioners and letting them know about the injury and the circumstances of the injury so that if you want to lodge a claim down the track there is a record of it somewhere.

When do WorkCover payments stop?

WorkCover payments stop when you are certified fit for full duties and you are able to return to work earning the same amount of income that you were earning prior to the injury.

They can also stop if the insurer decides to terminate them for some reason. One reason might be that an independent medical examiner has said that your incapacity for work is no longer related to the injury that you suffered.

If you’ve been on weekly payments for 130 weeks, and you have a work capacity, then your weekly payments will also stop (they can continue however if you’ve returned to work for not less than 15 hours per week and are earning at least $177 per week and you’re not likely to be able to increase your income).

Weekly payments can also continue beyond 130 weeks if you can show that you do not have a work capacity and that this is likely to continue indefinitely

When is WorkCover required?

A WorkCover claim will enable you to obtain medical and like expenses and weekly payments. If you are not likely to require any medical treatment or any time off work, then you are not likely to obtain any benefit from a WorkCover claim.

When does WorkCover cease?

There are a few different parts to a WorkCover claim in Victoria, and they ‘cease’ at different stages.

Your weekly payments will cease when you are no longer certified as having a restriction with your work capacity.

They will also cease, on many occasions, at the 130 week mark if you have a work capacity. You can get payments in addition to 130 weeks if you do not have a work capacity and this is likely to continue.

Your medical and like expenses, generally speaking will cease 52 weeks after your last weekly payment but there are exceptions to this.

Entitlement to the payment of medical like like services does not cease if:

You return to work but you could not remain at work if a particular service was not provided to you.

Also if surgery is required or if you have a serious injury.

Likewise, the entitlement to the payment of medical and like expenses continues if you require modification of a prosthesis or that the service provided is essential to ensuring your health or ability to undertake the necessary activities of daily living does not deteriorate significantly.

That being said, even though your weekly payments or medical expenses have ceased, or that your medicals haven’t been getting paid for by the insurer for a while – that does not mean that you cannot request the insurer make further payments to you.

Your WorkCover claim does not close permanently like a door being shut and locked and prevent you from claiming further benefits.

If for example you haven’t claimed a particular medical expense for awhile, but wish to do so, you can still put that medical expense to the insurance company and ask that they pay for it. They will then make a decision as to whether they do or not.

If they say they won’t pay for the expense and you disagree with their decision, then you can appeal the decision.

In relation to your lump sum payments, you are only entitled to one lump sum for an impairment claim (unless you have hearing loss claim, you can pursue a further claim if you can show further hearing loss down the track), and one lump sum payment for common law damages.

When do WorkCover payments start?

WorkCover payments start once your claim has been accepted.

If your claim was rejected but later accepted down the track after conciliation or following a visit to the medical panel or court – then your payments will start then.

Once your claim is accepted, you will be paid benefits from the date of injury and will be backdated if necessary, unless there was some other agreement between the parties.

What will work cover pay for?

If you have an accepted WorkCover claim, then in general you are entitled to the payment of medical and like expenses and if your injury impacts your ability to work, you are entitled to the payment of weekly payments.

If you have a permanent impairment as a consequence of your injury then you’re able to pursue a lump sum called an impairment benefit.

In addition to this if your injury was caused by someone else’s negligence, then you may be able to pursue a common law claim for damages.

When will WorkCover pay me weekly payments?

The way things work in general is, the insurance company will pay your employer your weekly payments. It’s then up to your employer to pay you at their normal pay intervals. So if you were getting paid your weekly wage on a Tuesday when you were working, then this should continue while you’re on weekly payments

In a small number of cases, the WorkCover insurer will pay injured workers their weekly payments directly. If this applies to you then you should ask the specific insurance company when you’ll be paid.

Do you get paid on WorkCover?

Yes, WorkCover covers you for lost income but only to a degree.

If you suffering an incapacity to work as a consequence of your injury then you are entitled to claim weekly payments from the WorkCover insurer. However, you do not get paid the total amount of what you’ve lost and will lose.

The law says that an average of your earnings for the 12 month period prior to your injury needs to be taken. Then, for the first 13 weeks you are entitled to be paid at 95% of that figure and there after you are paid at the rate of 80%.

For most people any shift allowance for overtime will be factored in to the calculations for the first 12 month period.

Who pays for WorkCover?

All employers in Victoria are required to have WorkCover insurance. Any benefits paid to injured workers are then paid by the WorkCover insurer.

These WorkCover insurers in Victoria are: Allianz, CGU, XChanging and EML

How to do a WorkCover claim?

In order to start a WorkCover claim you need to complete the appropriate WorkCover claim form and then give that to your employer or WorkSafe.

For more in-depth information in relation to how to lodge a claim, you can visit this page.

Where to get WorkCover forms?

All of the most commonly used WorkCover forms for injured workers can be found on this page.

Alternatively, you can contact WorkSafe and ask them to send you the appropriate form or forms that you are after.

Are WorkCover payments taxed?

Weekly payments from the WorkCover insurer are considered income and therefore a subject to tax just as if you were earning income from your job.

Are WorkCover reimbursements taxable?

If the WorkCover insurer reimburses you for a particular expense, say for example a medical expense, then no the reimbursement is not subject to tax. It is not classed as income.

Are WorkCover payouts taxable?

An impairment benefit lump sum claim is considered to be compensation for pain and suffering and therefore is not subject to tax.

Likewise, you are not required to pay tax on a common-law claim for damages (lump sum claim).

Is a WorkCover claim is confidential?

Once you lodge an initial WorkCover claim, then there is a record of that claim. The insurance company will have a record, as will WorkSafe.

All of the claims that you’ve lodged over the years will be recorded. A copy of this record can be obtained, but only with your consent.

Sometimes, WorkCover claims, in particular those where you pursue common law damages or other court cases can end up in court and those decisions made by the court can be made public.

Are WorkCover payments subject to super?

If you have an accepted WorkCover claim and you’ve been in receipt of weekly payments for at least 52 weeks, then you are entitled to the payment of superannuation contributions from your employer.

When does WorkCover offer a compensation payout?

Generally speaking, the insurer will not mention to you when it’s time pursue an impairment benefit lump sum claim during the life of your WorkCover claim. Likewise, for a common law damages claim.

It’s up to you or your lawyer if you have one to determine when the appropriate time to pursue either of those claims is.

Generally speaking, the appropriate time is when your injuries have stabilised. That is they are not getting any better, not getting any worse. When an injury is stable of course depends upon the nature of your injury.

If for example surgery is likely to occur in the near future, then your injury can’t be considered to be stable. You will need to wait until you’ve had the surgery and recovered from the surgery before your injury can be considered stable.

Can WorkCover stop payments?

Yes, WorkCover can stop weekly payments in a number of circumstances.

Some of the most common circumstances are:

If you are certified fit for full duties.

If you reach the 130 week mark and you have a work capacity.

If you don’t provide certificates of capacity to the WorkCover insurer.

If you are not complying with your return to work obligations. This might be for example if you are not making yourself available to have discussions with the occupational rehabilitation provider that the WorkSafe insurer has organised.

If the WorkCover insurer does stop your weekly payments, and keep in mind that you can appeal the decision to conciliation and beyond that if necessary.

Further information can be found here

Can WorkCover access medical records?

Yes, the WorkCover insurer can access medical records but they first need your consent to access them. So before they can access your medical records, you will need to sign a document giving them permission to get them.

Some medical practitioners rooms, even if they have received a signed document from you indicating your consent, will contact you and ask you whether you are happy for your full medical records to be released.

In other circumstances, you might have a court case on foot. If so, then it is possible for the opposing party to issue subpoenas that require a medical practitioner to hand over a copy of your medical records.

Can a WorkCover claim be reopened in Victoria?

Many times when people think their WorkCover claim is closed, it isn’t. Even if it has been years since you’ve claimed anything under a particular WorkCover claim, that does not mean that you cannot potentially claim something something under that claim again.

The important question is what the law says about whether you have an entitlement to what you’re claiming.

For example, say you stopped getting WorkCover weekly payments and returned to work, but a year or two down the track you want go back on payments because of the injury and not being able to work. The question here is not whether your claim is ‘closed’ or not.

It’s what the law says about whether you still have an entitlement or not. Have you reached the 130 week period? Is your doctor certifying you on fit for any duties or fit for modified duties? Is your doctor saying that your current incapacity for work is due to the original injury?

So, yes, you can ‘reopen’ a WorkCover claim because it is never really closed. It just depends upon whether you have an entitlement to claim something. If you’re not sure whether you have an entitlement to claim something – you can always put it to the insurer and ask them to make a decision on the matter and then go from there.

Who pays WorkCover benefits?

It is the responsibility of the Victorian WorkCover authority, via one of their authorised insurers, to pay you any benefits that you may be entitled to. It is not the responsibility of your employer to pay you benefits.

If you’re on weekly payments, you might notice that these come from your employer. However what generally happens is the insurance company will pay the employer your weekly payments and your employer will then pass these on to you but they are not actually paying them out of their own pocket.

All Victorian companies that employ workers must have WorkCover insurance. The exception to this is any companies that are liable to pay less than $7500 in the financial year in remuneration to employees.

Sole traders, individuals in a partnership or individual trustee of a trust that doesn’t employ any other people do not need to register for WorkCover.

Who is covered under WorkCover?

WorkCover covers injured Victorian workers in case of injury. Anyone who suffers a workplace injury or an injury connected to their work is able to make a WorkCover claim for compensation.

The distinction between who is a worker and who is a contractor is important.

A worker is defined as someone who;

Performs work for an employer, or

Agrees with employer to perform work

At the employees direction, instructional request, whether under a contract of employment or otherwise or

Who is deemed to be a worker by the legislation.

A contractor on the other hand is someone who is deemed to be working under what’s called a contract of service.

This can be tricky answer question to answer so you should obtain advice in relation to this if you’re not sure whether you’re a worker under the law.

How long to make a WorkCover claim?

You should lodge a claim as soon as possible following your injury in an ideal world. A claim should be lodged within 30 days from the date of your injury. However, reality is that many people are not ready to lodge a WorkCover claim for various reasons within this time period.

The fact that you’ve not lodged a claim within 30 days and perhaps you waited months or years, doesn’t necessarily prevent you from having an accepted WorkCover claim.

What is more important is the evidence that exists. What evidence exists to prove that you suffered an injury in the circumstances that you say in which the injury happened.

Did you report the injury to your employer? Did you attend your general practitioner or a physiotherapist after suffering the injury and did they make a note of what you told them about the nature of the injury and how it occurred? Did you tell a colleague about the injury? Did you make a note in your diary about how the injury happened?

If you don’t wish to lodge a claim straightaway, you should ensure that the injury is documented somewhere so a WorkCover claim can be pursued down the track if you wish to do so.

How can WorkCover/WorkSafe help injured workers?

The first way is by payment of medical and like expenses if you need them. The second way is if there’s a restriction on your ability to work and earn income is consequence of the injury, you can be paid weekly payments.

If you are left with a permanent impairment there are two potential lump sum claims that you can pursue.

The second of these, a common-law claim for damages, in some cases people can be compensated for loss of earnings that they have suffered and will suffer into the future.

In addition to this, the WorkCover insurer, if you are not able to get back to your old job because of your injury, can help pay for some retraining to assist you to find a new job.

How do I deal with WorkCover?

Many injured workers find dealing with the WorkCover very frustrating. They get annoyed by representatives from the insurance company not returning calls or emails.

They also get annoyed with the WorkCover insurer organising medical appointments for them to be assessed and making decisions in relation to their claim that they don’t agree with.

Unfortunately, these things happen and are sometimes unavoidable.

The best way to reduce the frustration is to engage a lawyer that can assist you in relation to not only your no fault benefits but also your common law entitlement.

It seems to be that the two issues that cause the most frustration at work for injured workers relate to medical and like expenses and weekly payments.

Problems with WorkCover – what do I do?

It’s not uncommon for injured workers to have problems dealing with WorkCover insurers. This is even the case if they have a lawyer.

Typical problems that injured workers experience are:

The Insurance company not returning calls or emails

Insurance company losing or miss placing documents in the injured worker having to send through the copies

Frustration with having to attend another independent medical examination

Decisions being made in relation to the WorkCover claim that a person may disagree with such as refusing to pay for a medical expense that they need or terminating weekly payments based on the report of an independent medical examiner.

Feeling like the occupational rehabilitation provider is pushing an injured worker to return to work.

The best way to reduce the problems that you have with WorkCover is to understand the system itself and how you can deal with issues.

You can also get legal advice and representation but of course this comes at a cost.

If you are dealing with the matter with WorkCover yourself and feel like you’re not getting anywhere then you should asked to speak to the team leader of the department that you were dealing with.

WorkCover and returning to work

If after an injury you’ve been off work for a while, at some point if this is likely that you’ll hear from an occupational rehabilitation provider that has been organised by the WorkCover insurer.

The job of this occupational rehab provider is to try and get you to return to work with your pre-injury employer, or if you are not able to do so, to get you into a new role with a new employer.

You’ll find that from time to time you’ll have discussions with them about how your injury is progressing. Some workers can find this particularly annoying but unfortunately it is part of the process.

As far as returning to work is concerned, the bottom line is this. A return to work plan needs to be signed off by your treating medical practitioner. If you’re treating medical practitioner is not willing to sign off on a return to work plan, then you shouldn’t be returning to work. Likewise, if you’re being certified unfit for any duties, then you shouldn’t be returning to work.

You should ensure that you’re treating general practitioner is aware as to what your job actually involves so when it comes time to signing off on a return to work plan, the doctor can make an informed decision as to whether, firstly, you should be returning to work and secondly, if you should, what restrictions should apply, if any.

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.

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

Written by the Work Injury Site team