WorkCover Mental Health Claims QLD: Complete 2026 Payout & Process Guide
Successfully lodging a WorkCover mental health claim in Queensland takes more than a doctor’s certificate. Since the July 2025 reforms, workers must now submit their own application to trigger any benefits.
Mental health claims are assessed under specific legal rules — including whether work was a ‘significant contributing factor’ and if the issue arose from ‘reasonable management action’ — which means how you record and explain your claim from the start really matters.
This guide walks you through the 2026 mental health claims process: from whether you’re eligible to how much you could be paid — and what to do if WorkCover denies your claim.
Overview: The three phases of a WorkCover journey
In Queensland, a mental health WorkCover claim isn’t a one-off event — it’s a process that can change over time as your recovery progresses. Many workers will only ever deal with the first phase, while others may move through all three.
Having a clear picture of these phases from the start makes it easier to understand how the 2026 claims process fits together and where different types of compensation may come into play.
| Stage | What it provides |
| Stage 1: Statutory ‘no fault’ WorkCover claim | Immediate support: weekly payments for lost wages and coverage for medical and psychological treatment. |
| Stage 2: Permanent impairment assessment | A one-off lump sum offer based on your Degree of Permanent Impairment (DPI) once your condition has stabilised. |
| Stage 3: Common law claim | A larger settlement if you can prove your employer’s negligence caused your injury. |
Am I eligible for a WorkCover mental health claim?
You may be eligible to make a WorkCover claim if a work-related mental health condition has reduced or stopped your ability to work.
In most cases, eligibility does not depend on:
- How your condition developed or who was at fault.
- Whether you’re employed full-time, part-time or casually.
- Whether you’re a subcontractor (in some cases).
What matters most is that your work was a ‘significant contributing factor’ to your mental health condition.
If you’re unsure whether you’re eligible for a WorkCover claim, use our free claim checker to find out in minutes.
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Find out if you’re eligible for a Queensland mental health claim today.
Some websites and resources incorrectly state that work must be the ‘major significant contributing factor’ to a mental health condition to qualify for WorkCover. This is no longer correct.
In Queensland, the law changed in 2019 to remove the word ‘major’ for psychiatric injury claims. This higher threshold applied between 2013 and 2019 (often referred to as the Newman Amendments), but it no longer applies.
Today, it is sufficient that work be a significant contributing factor to the development of your mental health condition.
From May 2021, Queensland has introduced a significant reform for first responders diagnosed with Post-Traumatic Stress Disorder (PTSD) (WorkSafe QLD).
If you are a first responder (such as a police officer, paramedic, firefighter, corrective services officer, or emergency communications worker) and you’re diagnosed with PTSD by a psychiatrist, the law presumes your condition is work-related.
This means you do not have to prove that your PTSD was caused by your job. Instead, WorkCover must accept your claim unless it can prove otherwise.
This is known as the PTSD presumption, and it represents a major legislative win for Queensland first responders who are routinely exposed to traumatic events as part of their work.
What mental health conditions can I claim for in Queensland?
To receive WorkCover compensation, you need to be diagnosed with a recognised psychiatric condition, such as:
- Adjustment Disorder.
- Post-Traumatic Stress Disorder (PTSD).
Unfortunately, stress alone won’t qualify for WorkCover, unless that stress leads to a recognised psychiatric condition.
What is the WorkCover mental health claims process?
Every statutory WorkCover claim in Queensland is unique, but these are the usual steps you can expect:
If you’re experiencing a work-related mental health condition, see a GP as soon as possible. Your doctor will assess your condition and, if appropriate, issue a Work Capacity Certificate. This document confirms:
- Your psychological injury.
- Your capacity for work.
- Recommended treatment.
- Any return-to-work restrictions.
Tell your employer about your injury as soon as possible. Most employers will ask you to complete an incident or injury report for their records. Keep a copy for yourself and ensure the details are clear, accurate, and factual.
Time limits apply, so it’s important not to delay this step.
Once you have a Work Capacity Certificate, you can lodge your claim with WorkCover Queensland. You’ll need:
- Your personal and employer details.
- Your Work Capacity Certificate.
- Bank and tax details.
- A brief description of how the psychological injury occurred at work.
After lodgement, you’ll receive a claim number and can manage your claim through Worker Assist.
Important update for 2025/26: Previously, a WorkCover claim could be started automatically when your doctor sent a Work Capacity Certificate (WCC) to WorkCover. From 1 July 2025, this no longer happens. You are now responsible for lodging your WorkCover claim yourself and attaching your Work Capacity Certificate to the claim form. A claim will not start unless you take this step.
This is a critical step many workers miss. While you’re waiting for your mental health claim to be processed, you can start getting some basic early treatment covered by WorkCover. Treatment might include:
- GP mental health appointments.
- Counselling or psychology sessions.
- Psychiatry appointments.
- Reasonable travel expenses incurred to access and attend treatment.
- Medication, such as antidepressants.
If WorkCover does not accept your claim, funding for your treatment will stop, but you won’t have to pay back the costs for treatment already received.
WorkCover aims to decide on psychological claims within 20 business days, though complex cases (like bullying or ‘reasonable management action’ disputes) can take longer.
- If your claim is accepted: Psychological treatment and support can begin (or continue, if you’ve received provisional treatment), and you may receive weekly compensation. Your employer usually pays the first week, then WorkCover manages ongoing payments.
- If your claim is denied: You’ll get a letter explaining why. You can request a review, but we strongly recommend consulting a lawyer first, as WorkCover disputes can be complex.
How much WorkCover compensation will I receive?
While you’re off work (or working less than before), WorkCover Queensland will pay weekly compensation to replace part of your income.
Eligibility depends on a few factors, such as:
- Acceptance of your psychological injury claim.
- Your capacity for work.
- Your Normal Weekly Earnings (NWE).
Weekly compensation rates
- First 26 weeks: You will generally receive 85% of your NWE or the amount payable under your award or industrial instrument. If no award applies, you receive the greater of 85% of NWE or 80% of Queensland Ordinary Time Earnings (QOTE), capped at your NWE (WorkSafe QLD).
- 26 weeks to 2 years: Weekly payments usually reduce to the greater of 75% of NWE or 70% of QOTE. As of July 2025, QOTE is $1,953.70 and is indexed annually (WorkSafe QLD).
- 2 to 5 years: If your injury results in 15% or more permanent impairment, you may receive payments of up to 75% of your Normal Weekly Earnings (NWE) for up to five years after the injury. If your permanent impairment is less than 15%, payments are limited to the single Age Pension rate.
Treatment and recovery expenses
WorkCover may also cover reasonable costs for:
- Psychological treatment (psychologists, psychiatrists).
- GP and specialist appointments.
- Hospitalisation (if required).
- Prescription medication.
- Rehabilitation and return-to-work support.
- Travel costs for treatment appointments.
Unlike physical injuries, psychological claims often focus heavily on ongoing therapy and psychiatric care, which can extend for years.
Additional compensation pathways: lump sums and common law claims
After securing weekly payments, you may be entitled to extra compensation if your mental health injury is permanent or resulted from your employer failing to maintain a safe workplace. Here’s how the process works:
Once your condition has reached Maximum Medical Improvement (usually 12+ months after the injury), you can request a permanent impairment assessment.
Your psychological DPI is assessed by the Medical Assessment Tribunal (MAT), based on the Psychiatric Impairment Rating Scale (PIRS). This looks at six specific areas of your life:
- Self-care and personal hygiene.
- Participation in social and recreational activities.
- Ability to travel.
- Social functioning (relationships).
- Concentration, persistence, and pace.
- Resilience (employability).
If WorkCover has not arranged a permanent impairment assessment, you should request one. Failing to do so may result in missing out on lump sum benefits.
Once your DPI is assessed, WorkCover will issue a Notice of Assessment (NOA) setting out:
- The accepted psychological injury.
- Your DPI percentage.
- A statutory lump sum offer (if your DPI is over 0%).
Unlike physical injuries, where you can dispute a doctor’s assessment and ask for a second opinion or a MAT referral, you cannot request a medical review of a MAT decision. Because the MAT is already the highest medical authority in the Queensland WorkCover system, their assessment of your DPI is final and binding.
If you wish to dispute the MAT’s decision, you’ll need to prove a legal error or provide significant new medical evidence within 12 months. It’s crucial to have a consultation with an experienced lawyer before starting a dispute. We can advise you on the best course of action and outline your realistic chances of success.
How is lump sum compensation calculated?
Lump sum compensation is calculated by multiplying your DPI by the maximum statutory amount, which is $422,292 for 2025 – 26.
| Degree of Impairment (DPI) | Estimated Total Payout (2025 – 26) |
| 5% DPI | $21,115 |
| 10% DPI | $42,229 |
| 20% DPI | $84,458 |
| 30% DPI | $142,611 |
| 40% DPI | $275,140 |
| 50% DPI | $407,652 |
| 65% DPI | $587,965 |
| 80% DPI | $788,278 |
| 100% DPI | $844,584 |
Data Source: WorkSafe QLD QOTE Notice 2025
If your DPI is 30% or higher, you may also be entitled to an additional lump sum, with payments increasing at a higher rate for each additional percentage point (Schedule 3 of the Workers Compensation and Rehabilitation Regulation 2014).
Once you receive your NOA, the path you take depends entirely on your DPI:
DPI 0%: No lump sum but full right to make a common law claim
If you are assessed at 0%, you won’t be offered a statutory lump sum payout. Don’t let this discourage you.
In 2026, many psychological claims result in a 0% DPI from the MAT because the clinical criteria for permanent impairment are extremely high. However, a 0% medical rating does not mean there was no injury or employer negligence. We’ve seen 0% assessments result in six-figure common law settlements because the court focuses on your loss of future earning capacity, not just your DPI.
DPI 1% – 19%: The critical decision
If your DPI falls in this range, you face a critical decision between:
- Accepting the statutory lump sum: You get the lump sum immediately, but you permanently waive your right to make a common law claim.
- Pursuing a common law claim: You reject the lump sum to seek a much larger common law settlement that covers future wages and pain and suffering.
Once an offer is accepted, you usually cannot undo that decision. That’s why it’s so important to speak with a WorkCover lawyer before accepting any lump sum offer.
DPI 20% or more: The dual right
If your DPI is 20% or higher, you can accept the statutory lump sum payout and still pursue a common law claim.
The lump sum offer remains open for up to three years until you accept it or start a common law damages claim.
How much will I get for a common law claim?
Unlike statutory WorkCover benefits, a successful common law claim can result in substantially higher compensation, reflecting the full impact of your injury.
Compensation may include:
- Past and future loss of income.
- Reduced future earning capacity.
- Ongoing psychological treatment costs.
- Care and support needs.
- Pain, suffering, and loss of enjoyment of life.
The 5% DPI myth for mental health claims: You may have read elsewhere that you need at least 5% DPI to make a common law claim for a psychological injury. This is no longer true. The 5% threshold was introduced in 2013 but was repealed in 2015 via amendments to the Workers Compensation and Rehabilitation Act 2003. This change applies to all injuries after 31 January 2015. In 2026, you can pursue a common law claim for a psychological injury regardless of your DPI, as long as you can prove your employer was at fault.
Do time limits apply to Queensland WorkCover claims?
In Queensland, the law sets strict time limits for making a WorkCover mental health claim. Missing these can mean losing your right to weekly wages and medical funding, so it’s important to claim before the deadline.
Statutory WorkCover time limits
Generally, a WorkCover claim must be lodged within six months of either:
- The day of the incident that caused your condition (for sudden events).
- The date a doctor first issues a Work Capacity Certificate (WCC) stating that your condition has impacted your ability to work (for conditions that develop over time).
Important tip: lodge ASAP to secure back pay
Don’t wait for the six-month mark; lodge your claim as soon as possible. If you claim more than 20 days after your injury or diagnosis, WorkCover may not backpay your lost wages to the start date. Instead, they may only cover you from the date you filed the paperwork.
Common law time limits
If you intend to sue your employer for negligence (a common law claim), you have three years from the date your condition was diagnosed to commence legal proceedings.
What if I’ve missed the time limit?
Don’t panic — you can apply to the court for an extension if you have a valid reason. Common reasons the court may accept include not realising the condition was work-related or being out of the state.
An experienced lawyer can review your medical history to see if you qualify for a time limit extension. We have a detailed understanding of time limits in Queensland and have helped hundreds of injured workers get their delayed claims approved.
How long can you be on WorkCover in Queensland?
In Queensland, the length of time you can receive WorkCover payments depends on the seriousness of your condition and your capacity to return to work. In most cases, weekly benefits are paid for up to five years or until you reach 65 years of age — whichever happens first.
Throughout this period, WorkCover Queensland will review your condition to confirm you still meet the eligibility requirements. If you’re being pressured to return to work before you’re medically ready, legal advice can help. With the right medical evidence, these decisions can be challenged, so your recovery isn’t rushed.
Why WorkCover might refuse a mental health claim
Mental health injuries have a significantly higher rejection rate in Queensland than physical ones. This isn’t because the injuries aren’t genuine, but because the legal criteria are more complex.
The most common reasons for a rejection include:
- The ‘significant contributing factor’ rule: Your claim could be rejected if WorkCover argues your condition was caused more by other issues (like family stress or a pre-existing condition) rather than your job.
- Lack of diagnosis: ‘Stress’ is a symptom, not a diagnosis. To get your WorkCover claim accepted, you must have a diagnosed condition like anxiety, depression, or PTSD.
- The ‘reasonable management action’ test: This is the biggest hurdle for most people making a mental health WorkCover claim. Unlike the other reasons, this is a legal exclusion that can block a claim even where work clearly contributed to the condition.
Understanding the ‘reasonable management’ test
Under Section 32(5) of the Workers Compensation and Rehabilitation Act 2003 (QLD), you cannot claim WorkCover for a mental health condition if it was caused by ‘reasonable management action taken in a reasonable way’.
Essentially, an employer is allowed to manage their business — even if those decisions cause you distress — provided they act fairly. However, for WorkCover to deny your claim using this rule, they must prove the employer met two objective standards:
- The action was reasonable: The decision must have a legitimate business basis. Common examples include performance reviews, disciplinary meetings for misconduct, or genuine redundancies.
- The action was carried out in a reasonable way: The manner in which the action happened is just as important as the action itself. A justified disciplinary meeting can become ‘unreasonable’ if it is carried out without notice or you are denied a support person.
Key precedent: In Carr v Workers’ Compensation Regulator (2022), the court found that while assigning workload might be part of management, imposing an ‘unattainable’ workload without proper support can be considered unreasonable management action.
Checklist: Was your employer’s conduct unreasonable?
If your employer’s behaviour crossed the line into being unfair or procedurally flawed, the reasonable management exclusion should not apply. Common red flags include:
- No warning: You were called into a serious disciplinary meeting without being told its purpose beforehand.
- Support denied: You weren't allowed to have a support person present during a difficult meeting.
- Lack of privacy: Management took disciplinary action or criticised your performance in front of other colleagues.
- Ignored policies: The company failed to follow its own internal HR manuals or grievance procedures.
- Aggressive behaviour: The manager used intimidating, belittling, or aggressive language or tone.
- Unfair targets: You were set impossible deadlines or targets without the resources or training to meet them.
If your claim was rejected based on reasonable management action but your experience matches any of the points above, you may have strong grounds to request a review of the decision.
What other mental health claims could I have?
Beyond your WorkCover and common law damages claims, a specialist lawyer will review your superannuation policy to uncover other benefits. These include:
- Total and Permanent Disability (TPD) claims: A lump sum payout designed for people who can no longer work due to a permanent injury or illness. It doesn’t matter how the injury happened or who’s to blame. Mental health conditions like PTSD, severe depression, and anxiety are now among the most common reasons for TPD payouts in Australia.
- Income protection claims: This provides ongoing monthly payments (usually 70%–75% of your income) while you are temporarily unable to work.
- Early release of super: In cases of extreme financial hardship or to fund essential medical treatment that isn't available through the public system, you may be able to access your actual super balance early.
While most super policies cover mental health conditions, some still have exclusions that can affect psychological claims. Older policies may have blanket exclusions that exclude mental health entirely, and insurers may also rely on pre-existing condition clauses if you had a prior history of stress, anxiety, or depression — even where your current condition was triggered by work.
How a lawyer can help with your WorkCover mental health claim
Mental health claims are often scrutinised more closely than physical injury claims. Because there’s no single test to prove psychological injury, insurers frequently argue symptoms are pre-existing or the result of reasonable management action, leading to many valid claims being delayed or rejected.
With more than 25 years’ experience in Queensland WorkCover law, we know where insurers are most likely to push back and how to respond. We don’t just lodge forms — we prepare and run mental health claims strategically from the beginning to give them the best chance of success.
Here’s how we assist:
- Early treatment access: We seek provisional payments so you can access psychiatric treatment and medication as early as possible, even while liability is being assessed.
- Targeted medical evidence: We obtain specialist reports that address the specific legal tests applied to mental health claims.
- Dealing with the insurer: We manage all communication with WorkCover or self-insurers, taking that burden off you.
- Identifying entitlements: We assess all potential benefits, including statutory compensation, common law damages, and any superannuation entitlements.
- Challenging adverse decisions: If a claim is rejected, we handle the review and appeal process and prepare the matter for litigation if required.
If your mental health is affecting your capacity to work, you don’t have to deal with the system on your own. A free, confidential discussion can help you understand your options and next steps.
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