Employer Injury Claim Report

• Employer Injury Claim Report (PDF 229kb)
  Document Type: Form
  Keycode: FOR589/07/08.07
  Category: Injury and Claims 
  Publication Date: 12 September 2007
  Date First Published: 11 October 2006
  Summary: This form is to be completed upon receipt of a Worker's Injury Claim Form for time loss and/or medical and like expenses, and upon receipt of a Dependant's Claim for Compensation.

About this form

An Employer Injury Claim Report is to be completed upon receipt of a Worker's Injury Claim Form for time loss and/or medical and like expenses, and upon receipt of a Dependant's Claim for Compensation.

You can obtain a copy of the form from:

• Your local Post Office;
• Your Authorised WorkCover Agent;
• The Advisory Service, or;
• By printing the PDF copy available on this website and making a photocopy for your own records.

Related information

If you fail to forward a claim and all forms as required, you may be required to pay a penalty and any interest owing to the worker under section 114E of the Accident Compensation Act 1985.

How to complete the form

If you have any problems about the acceptance or management of this claim, you should first talk to your Authorised WorkCover Agent. If you are still not satisfied, or you do not know who your WorkCover agent is, telephone the WorkCover Advisory Service on (03) 9641 1444 or, outside the metropolitan area, toll free on 1800 136 089.

Where to send the form

Forward claims to your WorkCover Agent.