The Queensland Workers’ Compensation Scheme provides coverage to Queensland workers who sustain a work-related injury or illness which prevents them from working and/or the work-related injury requires medical treatment.
Workers’ compensation can be:
weekly payments if the worker is unable to work
payment of reasonable medical treatment costs and rehabilitation costs.
A worker who sustains a work-related injury or illness is entitled to make a claim for workers’ compensation.
A claim for workers’ compensation is lodged with the relevant insurer for assessment. Queensland employers are required under legislation to participate in a workers’ compensation insurance scheme and WorkCover Queensland is the main provider of workers’ compensation insurance to Queensland employers.
Some large employers have a self-insurer’s licence and their workers’ compensation claims are handled by the self-insurer.
Claims are assessed by the insurer in accordance with the current legislation ie the Workers Compensation & Rehabilitation Act 2003.
Whilst the individual circumstances of each claim determine what sections of the legislation are relevant to whether the claim will be accepted or not, there are a number of sections that are always considered by an insurer when assessing a claim.
Some of these include:
has the claim been lodged within the required time?
does the worker fit the definition of “worker” as defined by the Act?
was the injury or illness sustained whilst performing their job or in connection to their job (did the injury or illness arise out of or in the course of employment)?
is employment a significant contributing factor to the injury or illness?
did the worker incur the injury whilst employed in Queensland or if incurred elsewhere is the worker’s principal place of employment in Queensland?
Simply lodging a claim does not mean the claim will be accepted.
Whilst the individual circumstances of each claim may vary, if the response is no to any of these questions during the insurers assessment of the claim, the claim may not be accepted.
If the insurer makes the decision not to accept the claim, the injured worker has the right to request a review of that decision. There are other decisions made by the insurer on a claim which can be reviewed, however not all decisions are reviewable.
Reviews are handled by the Workers’ Compensation Regulator, who are the independent regulatory authority in workers’ compensation matters in Queensland.