How to Make a Workers Compensation Claim: 5 Easy Steps
After a workplace injury, you might be stressed or overwhelmed at the thought of making a workers compensation claim. That’s why we’ve put together this easy claim guide.
In just five steps, you’ll understand exactly how to make a workers compensation claim: from lodging your claim form to gathering evidence proving your case. We’ll also explain when you can expect weekly payments to begin and what to do if the insurer delays or denies your workers comp claim.
Can I make a workers compensation claim?
Anyone who suffers an injury at (or because of) work is entitled to make a workers compensation claim. It’s also known as Workcover or a workman’s compensation claim.
Nearly all injuries, illnesses and psychological conditions are covered by workers compensation. It doesn’t matter who caused the accident, how it happened, or whether you’re employed part-time, full-time, or casually.
For more detailed information on which injuries and illnesses are covered by workers compensation, refer to our comprehensive guide.
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How to claim workers compensation in 5 steps
While each state has slightly different rules and everyone’s situation is unique, lodging a workers compensation claim typically involves these five steps:
1. Report the injury to your employer
You need to notify your employer in writing about your work injury as soon as possible and before a certain time limit. Importantly, the exact time limit that applies depends on which state you’re in:
| State | Time limits |
| NSW, QLD | Notify your employer within 30 days of injury and file a claim within 6 months. |
| VIC | Notify your employer as soon as possible and lodge a claim within 30 days of becoming aware of your injury or illness. |
| WA | Notify your employer as soon as possible and lodge a claim within 12 months. |
| SA, TAS, ACT | Notify your employer as soon as possible and file a claim within 6 months. |
| NT | Notify your employer within 7 days and lodge a claim within 6 months. |
Failing to report and file within the time limit can result in your claim being denied, even if you’re otherwise entitled to workers compensation payments.
However, if you’re outside the time limit, there are still options available — just speak to a lawyer immediately. Over the years, we’ve helped hundreds of injured workers make successful delayed claims.
2. Request a claim form
When you report your injury to your employer, they should give you a workers compensation claim form. However, if your employer refuses to provide one or you don’t want to deal directly with them, you can get a form from your state workers compensation authority:
3. Get medical treatment and a certificate of capacity
If you haven’t already seen a GP, psychiatrist or other relevant medical professional, it’s essential to get a formal diagnosis before filing a claim. Not only does this ensure you get proper treatment for your injuries, but your medical professional will also give you a ‘certificate of capacity’ to support your claim. This document outlines the nature of your condition, how it could affect your work capacity, and any treatment you require.
Importantly, in some states, you may need to visit an approved doctor for your claim to be valid.
4. Lodge your claim form
Complete and lodge your workers compensation claim form with your state’s workers compensation scheme or your employer’s insurer. This form typically requires details about your injury, how it occurred, and its impact on your ability to work. You’ll also need to attach your certificate of capacity to support your workers compensation claim.
Once you’ve filed, you may be eligible for ‘provisional payments’ while the insurer assesses your claim. These provide basic cover for lost wages and medical expenses, usually beginning seven days after you tell the insurer about your injury.
In NSW, for example, your workers comp provisional payments cover:
- Up to 12 weeks of lost income.
- Up to $7,500 for necessary medical treatment.
5. Wait for the insurer’s decision
The insurer or workers compensation scheme will assess your claim. During this process, they may request additional information or medical reports to support your workers compensation claim. The insurer must make a decision within a certain time limit, which varies based on your state:
| State | Time limit for insurer decision |
| NSW | 21 days to assess the claim once they have received all necessary information and reports. |
| VIC, ACT, NT | 28 days to assess the claim once it’s received. |
| QLD | 20 business days to assess the claim once it has been lodged. |
| WA | 14 days to assess the claim once they have received all necessary information and reports. |
| SA | 10 business days to assess the claim once they have received all necessary information and reports. |
| TAS | 21 days to assess the claim once it’s received. |
Once the insurer accepts your claim, you should start receiving your full weekly workers comp payments within seven days. While you’re on workers compensation, you must continue to attend medical appointments and follow treatment plans. If you’re able to return to work in a reduced capacity or with modified duties, your employer must find you a suitable position.
Why is my workers comp claim taking longer than expected?
There are several reasons your workers compensation claim may be taking longer than expected. Some of the most common include:
- Incomplete documentation: if your claim form is incomplete or missing important information, the insurer may request additional details.
- Medical evidence: the insurer can ask for additional medical evidence or have you undergo extra medical examinations.
- Complexity: complex claims can take longer to resolve, particularly those involving severe injuries or mental health conditions.
- Disputes and investigations: if there is a dispute regarding the injury, its cause, or the extent of the disability, the insurer may conduct a lengthier investigation.
- Waiting for approval: particular aspects of your claim, like certain medical treatments or rehabilitation services, may need pre-approval from the insurer before they’re paid.
Importantly, if your claim isn’t approved or denied within the designated time frame, the insurer must provide a reason for the delay. If they fail to give you a reason or you believe your claim is being unfairly delayed, it’s crucial to consult with a specialist workers compensation lawyer. We have extensive experience dealing with insurers and can apply pressure to get your claim resolved faster.
What happens if the insurer denies my workman’s comp claim?
If your workers compensation claim is declined, you have the right to appeal the decision.
The insurer must provide a written notice detailing the reasons for declining your claim. At this stage, you can request a review of the decision. To succeed in your review, you’ll need to demonstrate that the insurer made a mistake in their decision.
We highly recommend seeking legal advice before navigating this complex process. Our experienced lawyers have a proven track record of getting disputed claims approved. In a complimentary consultation, we’ll assess your insurer’s decision and advise you on the most effective appeal strategy.
To learn more about what to do if your claim is denied, check out our guide to denied workers compensation claims.
How a lawyer can help with your workers compensation claim
For over 25 years, we’ve helped injured workers secure the compensation they deserve. As part of our comprehensive service, we’ll always:
- Explain your rights and how much you’re eligible to claim.
- Ensure you receive provisional payments as soon as possible.
- Make sure you get the support, treatment and time off work you need.
- Negotiate with the insurer on your behalf.
- Gather strong evidence to support your claim.
- Apply pressure to the insurer if your claim is unfairly delayed.
- Appeal the decision if your claim is rejected.
- Identify valuable additional entitlements, such as income protection, common law damages or a TPD payout.
Speak to us today for free advice on your workers compensation claim. Find out where you stand and how to get the maximum compensation
on for your injuries.
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