Navigating Your Workers’ Compensation Claim: A Comprehensive Guide

When filing a workers' compensation claim with WorkCover Queensland (or a self-insurer), various factors (criteria) are assessed to determine its acceptance. To guide you through this complex process and ensure you understand your rights and options, we've compiled a comprehensive guide to navigating your workers' compensation claim effectively.

In determining a claim, WorkCover Queensland examines the following aspects:

Was the claim submitted within the stipulated timeframe?
Was the claimant employed by the relevant employer at the time of the injury?
Is the claimant officially recognized as a worker?
Did a work-related incident lead to the injury?
Was the person's job a significant contributing factor to the injury (meaning a substantial portion of the cause)?

These criteria are outlined in the Workers Compensation and Rehabilitation Act 2003 (the Act).

Claims are not all decided in the same manner. Each claim is unique, as workers and injuries vary. The nature of the injury or the circumstances surrounding it may necessitate additional information to make a determination.

In certain cases, different criteria may be applied, especially for injuries such as mental injuries, industrial deafness, injuries occurring during travel to or from work, aggravated injuries with ongoing symptoms, work-related respiratory diseases, or diseases contracted during job-related activities (e.g., Q-fever). This also applies to cases involving death due to work-related events or illnesses with a prolonged onset (referred to as 'latent onset'), such as mesothelioma or malignant skin cancer.

Your claim – first steps

Your claim will be handled by a WorkCover team member who, depending on the nature of your claim, will gather the information they need to make a decision for you as quickly as possible.

We’ll contact you as soon as we can (generally within a few business days) after your application has been received, so you can give us details of your injury and any other information that’s needed.

We may also speak to your employer. This is to get details of your employment and wages and to let them know a claim has been made. There may also be other details we need to clarify or confirm.

As well as speaking to you and your employer, WorkCover might gather information from others such as your doctor, any witnesses to the incident and sometimes independent medical examiners. This will help us to decide your claim.

How long will it take to make a decision?

WorkCover aims to make a decision on claims in 20 business days or less, as outlined by legislation.

If you and your employer give us the right information straight away, we can often make a decision more quickly.

Sometimes it takes longer if we can’t get the information we need, like details from your employer, your work capacity certificate, or certain medical information if your injury or illness is more complex.

If we can’t decide your claim within 20 business days, we’ll call and let you know why. We’ll also put it in writing to you.

If you’re unhappy with the reasons your claim is taking longer than expected, you can ask for the Workers Compensation Regulator to review the reasons given.

If my claim is accepted

If WorkCover accepts your claim, there are different types of payments and support available, depending on your circumstances.

You may be compensated for lost wages. If this is the case, your employer will generally pay your first week's compensation (as the employer’s excess) and WorkCover will manage your payments after that, while you’re unable to work.

We’ll get your bank details and a tax declaration from you and talk to you about how you usually get paid. We’ll try to manage your payments to help minimise disruption to your normal life.

WorkCover will also help you with other expenses relating to your claim, like rehabilitation and getting you back to work.

If my claim isn't accepted

If your claim isn’t accepted, we’ll speak to you and let you know why. We’ll also put it in writing.

Learn more about what happens if a claim isn’t accepted and what your options are.

Common law only claims

As an injured worker, you might choose not to claim statutory benefits (for e.g. weekly compensation, medical expenses, rehabilitation costs etc.)

You might want to move forward with a common law claim (this means to sue your employer for damages if they're deemed at fault for your injury).

Keep in mind that common law claims still need to go through a similar decision-making process as outlined above.

My employer is self-insured. Is the process different?

WorkCover Queensland and self-insured employers are bound by the same workers compensation legislation.

However, a self-insured employer might have slightly different process. You should talk to your employer’s claims officer if you have questions.

I have more questions about my claim. Who can I talk to?

If you have questions about a claim that are not answered here, the contacts below may help.

Call WorkCover Queensland on 1300 362 128
If your employer self-insures, you can contact the relevant claims department
Employers can contact CCIQ’s Workers’ Compensation Helpline
Workers can contact the Queensland Council of Unions’ Workers’ Compensation Advisory Service