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:
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:
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.
If you are injured at work or have a work-related injury or illness you should seek medical attention as soon as possible. You have the right to attend your own treating doctor.
Report the incident to your employer as soon as possible and complete an incident report if you are able to.
When attending your doctor be sure to:
If the doctor diagnoses a workplace injury or illness, the doctor should issue a Workers’ Compensation Regulator Medical Certificate.
The doctor should note his opinion of the relationship between your employment and your injury on the certificate.
If your doctor thinks your injury has happened over a period of time from a specific task you perform, this should be recorded on the certificate.
If the insurer is WorkCover, you can lodge your application, a medical certificate from the Regulator and all additional information direct to WorkCover from most doctor surgeries.
Alternatively you can download an application from WorkCover and send by fax or email, or lodge your claim online.
If your employer is a self-insurer you will need to complete the appropriate application form available from the self-insurer.
The Workers’ Compensation Regualtor Medical Certificate issued by the doctor is in quadruplicate, with a copy for the employer, the insurer, the medical/dental practitioner and you.
You must provide your employer and the relevant insurer, with the copy of the medical certificate.
It is best to lodge an application for workers’ compensation as soon as possible to the time the injury was sustained and you attended a doctor in relation to the injury.
Legislation determines that an application for workers’ compensation must be lodged within six months of incurring a workplace injury or illness.
However a delay in lodging an application may mean benefits are not paid from the date the injury is sustained.
So it is in your best interest to lodge a claim as soon as the injury or illness has been sustained and you have attended a doctor in relation to the injury.
One of the most important aspects of a claim for workers’ compensation is establishing the link between the injury or illness and work.
Sometimes the doctor provides a clear opinion of the link between your work and your injury or illness and there may be no need to provide additional information.
However in some instances how a work-related injury or illness occurred is not so straight forward. You may need to write a statement outlining how the injury or illness occurred and seek additional evidence such as a letter or report from the doctor linking the injury to work, provide witness statements if an event was witnessed that is relevant to your claim.
Keep a copy for your own records of any forms, medical certificates and additional information you provide to WorkCover or the self-insurer.
Current legislation determines the insurer must make a decision on an application within 20 business days of the application being lodged.
Once the insurer has assessed an application they will make a decision whether to accept or reject the application.
If your application is accepted you will be notified by the relevant insurer ie WorkCover or the self-insurer.
For the duration of your work-related injury or illness you must provide up to date Workers’ Compensation Regulator medical certificates to your employer and to WorkCover (or self-insurer).
Medical Assessment Tribunals are run by the Workers’ Compensation Regulator and are an independent panel of doctors who make decisions about an injured worker’s work-related injury.
An insurer will usually refer an injured worker to a Medical Assessment Tribunal when:
Medical Assessment Tribunals consist of a panel of three or five specialist doctors and there are two different types of medical assessment tribunal panels:
Doctors on the panel are independent to the insurer and every effort is made to ensure a doctor who has been involved in the treatment or other assessment of the injured worker is not on the panel.
An injured worker can have a support person or advocate attend the tribunal with them to assist the injured worker explain specific details of their work duties relevant to their work-related injury. For example, explaining the frequency of specific movements when performing certain tasks, approximate weights involved, demonstrating the specific repetitive movements.
There is no legal argument to present to the panel at a Medical Assessment Tribunal. However having an advocate or support person attend the Tribunal with the injured worker can assist them to put forward specific information relevant to the injury.
If an injured worker wishes to engage a lawyer to attend the tribunal with them, the injured worker will be responsible for the associated cost.
For more information about Medical Assessment Tribunals visit:
GPO Box 2459
Brisbane Qld 4001
Ph 1300 362 128
or to find your nearest WorkCover service centre.
If your employer is a self-insurer or you do not know, for the list of self-insurers in the Queensland scheme and their contact details click here.
The Workers’ Compensation Regulator
PO Box 10119
Brisbane Adelaide Street 4000
For street address, fax number and other contact details visit the Regulator.
If you are a union member, always contact your union for assistance in the first instance.
If you are not a union member and do not have a current issue, it’s more important than ever to join a union now to protect your working conditions and salary. Find out how you can here.
If you are not a union member and you have an industrial issue the following contact details may be useful :
Fair Work Australia
1300 799 675
Queensland Workplace Rights Ombudsman
1300 737 841
If you have an issue with safety in your workplace contact Workplace Health & Safety Queensland www.whs.qld.gov.au.