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Things you should know about WorkCover claims

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Please note that this post was written for Queensland audiences and the information within may not apply to other regions.

Accidents happen. And when they do, and you’re injured, it can be a tough time knowing what the next step is. You’re likely going to be off work for a period of time, so how do you pay your bills? Or medical expenses?

If the accident happened at or because of your work, you may be eligible to claim workers’ compensation. In Queensland, majority of businesses insure their workers through WorkCover Queensland – in fact, it’s a legal requirement to take out accident insurance for every employee on the books.

But knowing how or when or what type of WorkCover claim to make isn’t always common knowledge. So, we’ve made a list of important things to know about WorkCover claims.

You don’t have to prove fault to claim statutory WorkCover benefits

More often than not, work accidents are just that – accidents.

That’s why the WorkCover Queensland scheme is non-fault based, meaning it doesn’t matter whose fault the accident that caused your injury was, you are entitled to claim statutory workers’ compensation (as long as the injury happened at or because of your work).

But this doesn’t mean you can’t take it further if someone else was responsible for your injuries. WorkCover Queensland also cover common law claims for damages – in which case you do have to prove that someone was negligent and failed in their duty of care to keep you safe from injury.

And despite the workers’ compensation stigma, you do have rights.

Workers’ compensation covers more than just lost wages

It’s well-known that workers’ compensation covers part of your wages while you’re off work. But WorkCover Queensland may also pay for medical expenses related to your work injury.

These can include anything from rehabilitation treatments or doctor’s appointments, medication, to any domestic assistance you may need while you recover, and even the cost of travel to and from medical appointments.

And if you’ve lodged a common law claim (that is, a claim for negligence), you’re likely to also be compensated for pain and suffering which is designed to compensate for the effects of the injury and loss of enjoyment of life.

This type of payment comes in the form of a lump sum and requires a separate claim to be lodged in addition to a statutory claim.

WorkCover benefits don’t cover your full wages

Just like with income protection insurance, how much you receive from WorkCover Queensland is a percentage of your normal income. This is because the benefits aren’t actually a wage – it’s an insurance payment, or better known as an income replacement benefit.

These weekly benefits are paid by the insurer (either directly to you, or through your employer) at a rate less than your normal income until you’re able to return to work in the same capacity as before your injury. The amount is calculated based on an average of your earnings for the 12 months prior to an injury and is generally paid as:

  • Up to 85% of your normal weekly earnings for the first 26 weeks you’re unable to work; then
  • Up to 75% of your normal weekly earnings for between 26 weeks and five years

The same goes for other expenses related to your injury. While WorkCover does also pay for approved medical expenses and assistance services, it’s usually at what they deem a “reasonable” cost, which doesn’t always mean the full amount.

It is possible to appeal a WorkCover decision

Both you and your employer have the ability to appeal a WorkCover decision – whether it’s because you disagree with a decision to end your weekly payments, or your boss doesn’t agree the injury resulted from employment.

One of the main reasons workers appeal a WorkCover decision is because their claim was rejected. There are many reasons why WorkCover may deny your application. For example, you might have lodged it too late, or you don’t have enough proof your injury happened at work.

The good news is, an appeal goes through a free independent review process by the Workers’ Compensation Regulator. It’s important to note there are strict timeframes you have to stick to – most notably, you must request the review within three months from the date you received the decision that you disagree with.

There are time limits to make a WorkCover claim

Work injury claims have timeframes that must be observed. One of the most important time limits to know if you’re thinking about lodging a WorkCover claim for statutory benefits, is that you only have six months from the injury occurring (or an injury becoming apparent) to file a claim.

WorkCover Queensland do have the discretion to waive these time limits if you have a reasonable cause. However, there are only a handful of such exceptional circumstances, including if a medical assessment tribunal determines the delay was caused by something of a medical nature; or if it was due to an honest mistake or other reasonable cause.

When considering a common law claim, however (that is, suing your boss for negligence), you generally have three years following the work accident to lodge the notice. To do this, you have to either request WorkCover undertake a permanent impairment assessment, or give them a Notice of Claim Damages application within that time.

Note: Your employer and WorkCover also have time limits they should adhere to.

Payments from WorkCover also have a time limit

Not only are there time limits to lodging a workers compensation claim, how long you can receive statutory workers’ compensation payments for is also limited and depends on a variety of factors, primarily injury severity (and how long you’re off work).

In most work injury compensation cases, injured workers recover and are able to return to work within a short time, in which case their weekly WorkCover payments would stop.

However, some aren’t that fortunate because they may have suffered an injury that’s caused permanent damage to their body and consequently their ability to work. If an injury is deemed a “permanent impairment” you will likely receive a lump sum offer from WorkCover to cease your weekly benefits. This figure is generally less than what a lawyer will be able to secure for you, so we recommend seeking legal advice before you accept this offer as once you’ve accepted it, you’re not able to ask for more.

If after five years you still haven’t returned to work due to your injury, and you haven’t received a permanent impairment diagnosis, your payments will also stop.