After your claim is submitted
Once your claim has been submitted, your WorkSafe agent will assess your claim and work out what payments you'll receive for medical treatment and/or time you need to take off work.
Getting treatment while a decision on your claim is made
Your health is the most important thing. You should visit your general practitioner (GP) or healthcare provider as soon as possible. If your claim is then accepted, you can later be reimbursed for the reasonable costs of treatment.
If you have sustained a work-related mental injury, you may also be entitled to access early support for the reasonable costs of medical treatment and services for up to 13 weeks while you await the outcome of your claim. This support is called provisional payments.
Once you have lodged a claim form, your entitlement to provisional payments will usually be determined within five business days. If entitled, your WorkSafe agent will provide you with a claim number. Your healthcare provider can use this claim number to bill WorkSafe directly for your reasonable medical treatment or services while the outcome of your claim is being determined.
It's important to note that payment of the reasonable costs of medical treatment and services does not necessarily mean payment of the full costs. There may be a 'gap' between what the provider charges and what is payable under WorkSafe's schedule of fees.
Assessment of your claim
Your WorkSafe agent is responsible for assessing your claim and determining liability.
Decisions on liability must be made within certain timeframes as determined by legislation. For most claims, this is 28 days from receipt.
For claims including a work-related mental injury, entitlement to provisional payments will usually be determined in five business days from the date you submit the claim.
If your claim is accepted
Your agent will let you know in writing that the claim has been accepted and provide other important information, including the amount of the weekly payments (if applicable).
The steps
Weekly payments for time lost from work 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.
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.
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.
A clearance certificate is a Certificate of Capacity where your healthcare provider 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.
If your claim is rejected
You may be entitled to use any sick leave or other appropriate leave that you've accrued to cover time off work.
If your rejected claim included a work-related mental injury and you were entitled to provisional payments while the claim was being determined, these payments can continue for up to 13 weeks.
You also 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.
- You can contact the Workplace Injury Commission (WIC) - a free independent service offered by the Victorian Government to help resolve disputes. This can either be done at the same time as step 3, or after the review is complete.
- Contact WorkCover Assist – a free service provided by WorkSafe to help you with your dispute as it goes through the WIC. A union may also be able to offer support.
- If you don't reach a resolution through the WIC via conciliation, and you have been issued with a Genuine Dispute Certificate, you may be eligible to:
- request a review by the Workers Compensation Independent Review Service
- lodge a referral with WIC for arbitration (if your injury occurred on or after 1 September 2022)
- take your dispute to court.