Claims process and what to expect

On this page

  1. Instructions to help you understand the claims process
  2. The forms you'll need to complete to lodge a claim

Step by step guide

These are the steps you should take if you or one of your workers become injured at work.

Stage 1: Someone becomes injured or ill because of work

The worker's health is the most important thing. If an accident happens make sure you receive appropriate treatment as soon as possible.

  • Employer's responsibilities
    Notify WorkSafe

    If the incident is serious and causes or could have caused serious injury or death, you must report it to WorkSafe immediately on 13 23 60.

    You must also send a completed incident notification form to WorkSafe within 48 hours and keep a copy of the completed form in your records for five years. This applies to all incidents that take place at your workplace even if the injured person is not one of your workers.

    Fill out your register of injuries

    Any injury or illness should be recorded in your workplace's register of injuries [doc, 59kb] by the injured worker or someone on their behalf.

    Look for tasks that your worker can do

    Look for tasks that your worker can do at work rather than what they can't do and talk to them about it. People generally recover better and faster if they can safely stay at work while they recover.

    Start planning for return to work

    When you know a worker is injured and can't perform their normal duties, it's important to start planning and provide them with return to work information.

    If your injured worker has visited the doctor, the doctor may call you to talk about options to help them return to work as soon as safely possible.

  • Worker's responsibilities
    Get appropriate treatment

    Your health is the most important thing. Just remember to keep all your receipts and invoices for any treatment you receive.

    Notify your employer in writing

    Your injury needs to be recorded in your workplace's register of injuries within 30 days.

    • This should be done by you, or someone on your behalf
    • If you don't do this within 30 days you may not be entitled to compensation
    • If you're not able to record your injury in the register of injuries, you still need to notify your employer in writing within 30 days.

    Talk to your employer and let them know about any time away from work or assistance that you need to return to safe work, which could include reduced hours or modifications to your duties or work area.

    Decide whether you want to lodge a claim

    If you lose income or require treatment because of your injury and you wish to claim compensation from WorkSafe, you need to make a claim.

Stage 2: Decide if you want to make a claim

You can choose to make a claim to cover many out of pocket expenses and loss of income. If your injury is the result of a motor vehicle accident, you must also report the accident to the police.

  • Employer's responsibilities
    Your worker should tell you if they want to make a WorkCover claim

    They will need to fill out the worker's injury claim form and give it to you to complete the employer section. You need to acknowledge that you've received the claim form in writing – you can do this by completing the employer section of the worker's injury claim form and giving the worker a copy.

    You should follow the same process if you receive a dependent's claim for compensation form.

    Complete the employer injury claim report

    Complete an employer injury claim report and lodge it with your WorkSafe Agent along with these documents:

    • Worker's injury claim form
    • Injured worker's medical certificate ('Certificate of Capacity')
    • Any other relevant documents like invoices or receipts for medical expenses.

    You can lodge it through your WorkSafe Agent's online claim lodgement system or by post.

    You have 10 calendar days to lodge the claim with your WorkSafe Agent from the time you receive the worker's injury claim form from your worker – there can be penalties for failing to meet this timeframe. Your WorkSafe Agent has 28 days to assess the claim and let you know the outcome.

    You may be asked to cooperate with a Circumstance Investigator

    A Circumstance Investigator may be appointed to collect more information including interviewing witnesses about your worker's injury. This is your chance to give your WorkSafe Agent detailed information about the injury and the events that took place.

    After you lodge the claim

    Your WorkSafe Agent will tell you if it has been accepted within 28 days.

  • Worker's responsibilities
    Plan your return to work with your employer

    Continue to talk to your employer about your time away from work or assistance that you need to return to safe work.

    Your employer must consult directly with you about your return to work, but if you need support, you can be represented and assisted during any consultation – but your representative cannot be a legal practitioner.

    Get a Certificate of Capacity

    If you want to claim for loss of income (weekly payments), you'll need to give your employer a Certificate of Capacity issued by a medical practitioner.

    The first certificate can cover up to the first 14 days of work capacity.

    Tell your employer if you want to make a WorkCover claim

    Fill out the worker's injury claim form and give it to your employer to complete along with your Certificate of Capacity. Your employer should acknowledge that they've received the claim form from you.

    If you're not able to download the form, you can also get one:

    • from an Australia Post outlet
    • from your employer's WorkSafe Agent
    • by contacting the WorkSafe Advisory Service on 1800 136 089 or info@worksafe.vic.gov.au.

    Your employer has 10 calendar days to lodge the claim after receiving the worker's injury claim form from you.

    You may need to attend an examination

    Independent medical examinations are used to provide impartial information to help your WorkSafe Agent make decisions about your worker's entitlement to weekly payments and treatment and to support their recovery, rehabilitation and return to safe work.

    You may be asked to provide a statement

    A Circumstance Investigator may be appointed to collect more information including interviewing witnesses about your worker's injury. This is your chance to give your WorkSafe Agent detailed information about the injury and the events that took place.

    After your employer lodges the claim

    Your WorkSafe Agent will tell you if it has been accepted in writing within 28 days.

Stage 3: Continue to plan for a return to work

It's important that workers and employers communicate with each other regularly and you plan for a safe return to work together.

  • Employer's responsibilities
    Appoint a Return to Work Coordinator

    If your worker has an incapacity for work and you don't already have a Return to Work Coordinator, you're required to appoint one.

    It's important to appoint some that's empowered to speak on your behalf (or on behalf of the employer), make return to work related decisions and help you meet your return to work obligations.

    Develop a return to work plan

    When someone isn't working their health and wellbeing can suffer, so it's critical to start the planning process for a timely and safe return to work using the return to work planning arrangements template.

    Return to work planning is only successful when your worker and their treating health practitioner are involved. You have an obligation to consult with the treating health practitioner when the worker gives consent.

    You should also include your WorkSafe Agent and your worker's occupational rehabilitation provider if there is one.

  • Worker's responsibilities
    Continue to send Certificates of Capacity to your employer

    If you need more time off work, modified duties or modified hours after the first 14 days you'll need a new Certificate of Capacity. Each new certificate can cover up to 28 days and can be provided by your:

    • medical practitioner
    • chiropractor
    • osteopath
    • physiotherapist.

    Your employer can't pay you weekly payments for loss of income until they receive the correct Certificate of Capacity. You must sign the Certificate of Capacity for it to be valid.

    Your weekly payments are based on your 52 weeks of earnings (or less if applicable) before your injury or illness, and your certificates.

    Request approval before you access some treatments

    Some treatments need to be approved by your employer or the WorkSafe Agent before you can access them.

    Send your treatment invoices and receipts to your employer until you're advised not to

    Your employer generally pays an excess before the WorkSafe Agent takes over paying the reasonable costs of your treatment.

    Send your treatment invoices and receipts to your WorkSafe Agent if asked

    Once your employer has paid the excess amount your treatment invoices and receipts should be sent to the WorkSafe Agent. Your employer or WorkSafe Agent will tell you when it's time to start doing this.

    Ask your treatment providers to bill the WorkSafe Agent directly

    Ask your healthcare providers if they can send their accounts direct to WorkSafe so we can pay for the approved cost of treatment.

Stage 4A: If the claim is accepted

Returning to work after an injury or illness isn't always easy. But it can help you to recover sooner and return to your normal life.

  • Employer's responsibilities
    Make sure your worker continues to be paid if they lose income

    Your worker will give you a medical certificate called a Certificate of Capacity if they need time off work or modified duties or hours.

    If your worker's weekly payments claim is accepted as part of the excess of your insurance premium, you are liable to pay the first 10 days of the injured worker's incapacity for work, unless you've selected the 'excess buyout' option on your WorkCover insurance premium. If you do not have the excess buyout option, your WorkSafe Agent will tell you the amount you must pay your worker. This is based on the information you've given them about the worker's pre-injury average weekly earnings (over the last 52 weeks or less if applicable).

    Fill out the calculating pre-injury average weekly earnings form and send it to your WorkSafe Agent.

    Your WorkSafe Agent will reimburse you for any weekly payments that you make to your worker over after the first 10 days and before they return to full duties.

    Forward any Certificates of Capacity to your WorkSafe Agent

    Forward all Certificates of Capacity to your WorkSafe Agent as soon as you receive them from your worker. Your WorkSafe Agent will keep track of how much you've paid your worker and make any adjustments – the level of weekly payments decreases after payments have been received for 13 weeks and 52 weeks.

    Pay any medical excess

    As part of the excess of your insurance premium you are liable for the employer excess, the first $692 (2017/18) (indexed annually), for the reasonable costs of medical and related expenses your worker requires, unless you have selected the excess buyout option on your WorkCover insurance premium. If you do not have the excess buyout option, you must keep copies of all invoices or receipts and forward them to your WorkSafe Agent once you've paid the excess amount.

    After the excess has been paid, your WorkSafe Agent will work directly with your worker and their healthcare providers to pay for treatment. If you receive any invoices or receipts from your worker forward them to your WorkSafe Agent.

    For more information on avoiding paying the excess on your claims, refer to Insurance premium calculations under Remove your excess (excess buyout option).

    If you disagree with the decision to accept the claim

    You can request a review by WorkSafe in writing if you believe the claimant wasn't a 'worker' under Victorian workers compensation legislation or you weren't the correct employer of the worker at the time of their injury. Send your request to:

    The Manager, Premium Review Team
    WorkSafe
    GPO Box 4306
    Melbourne VIC 3001

    You must continue to comply with your return to work and payment obligations while the review is conducted.

  • Worker's responsibilities
    Be aware that your weekly payment will change at 13 and 52 weeks

    Weekly payments for your loss of income change at certain points during your claim. Two critical points are at 13 weeks and 52 weeks of payments.

    Your Agent will tell you about the changes in your weekly payments before they occur. 

    Be aware that your employer's obligations change at 52 weeks

    Your employer is required, within reason, to maintain your employment for 52 weeks while you have an incapacity for work - the 52 weeks may not necessarily be consecutive. 

    Provide your employer with a clearance certificate

    A clearance certificate is a Certificate of Capacity where your treating health practitioner will indicate that you are ready to return to your pre-injury work. It is a good idea to give it to your employer before undertaking your usual duties.

    After 52 weeks your employer has no obligation under Victorian workers' compensation legislation to re-employ you. If you have any questions about this, you should contact your WorkSafe Agent.

Stage 4B: If the claim has been rejected

If your claim is rejected you do have the right to request a review of the decision.

  • Employer's options
    Your worker can use their accrued leave entitlements

    Your worker is entitled to use any sick leave or other appropriate leave they've accrued to cover time off work.

  • Worker's options
    Understand your options

    You have the right to request a review of the decision. Your options are:

    • Speak to your employer as a first step
    • Contact the WorkSafe Advisory Service on 1800 136 089 for free and confidential advice
    • Ask your WorkSafe Agent to review the decision. The review will be made by a senior person that wasn't involved in the original decision
    • If you're not happy with the review decision you can contact the Accident Compensation Conciliation Service – a free independent service offered by the Victorian Government to help resolve disputes
    • Contact WorkCover Assist – a free service provided by WorkSafe to help you with your dispute as it goes through the Accident Compensation Conciliation Service
    • If you don't reach a resolution through the Accident Compensation Conciliation Service, you may be able to take your dispute to court.
    You can use your accrued leave entitlements

    You're entitled to use any sick leave or other appropriate leave that you've accrued to cover time off work.

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