How to Make a WorkCover Claim in Queensland After a Workplace Injury

Short answer: In Queensland, a person can lodge a statutory WorkCover claim without a lawyer. The usual first steps are to obtain medical care, tell the employer, obtain a valid Work Capacity Certificate, keep relevant records and submit the claim to WorkCover Queensland or the relevant self-insurer. Whether a claim is accepted and what support may be available depends on the facts, medical evidence and Queensland legislation. For the separate question of when legal advice may assist, see Do I need a workers’ compensation lawyer in Queensland?.

General information only: This guide is general legal education, not legal advice. It does not guarantee eligibility, acceptance, the availability of any benefit or a particular outcome. The official Queensland sources linked below should be checked for current process information.

What should you do first after a workplace injury?

If you are injured or become ill because of work in Queensland, you may be able to apply for workers’ compensation. Eligibility depends on the facts of the injury or illness and the applicable legislation. The WorkCover Queensland explanation of workers’ compensation describes work-related injuries and illnesses as potentially including physical or psychological injuries, work-related illnesses and existing conditions made worse by work, subject to the relevant rules.

First, obtain appropriate medical care and tell the treating practitioner that the injury or illness is work-related. Tell the employer what happened and keep a record of that communication. A report to the employer can help the insurer obtain employment information, but reporting the injury is not the same as lodging a workers’ compensation claim.

Ask an authorised medical practitioner for a valid Work Capacity Certificate, preserve relevant records and lodge the claim with the correct insurer. A person does not need to retain a lawyer merely to take these initial steps.

What is a Work Capacity Certificate?

A Work Capacity Certificate is a medical certificate for a workers’ compensation claim. It tells the insurer about the injury or illness, the treatment needed, whether time away from work is required, work restrictions and any workplace changes that may assist a return to work.

WorkSafe Queensland states that a claim application is not valid without a completed certificate. It may be issued by a registered medical practitioner, a nurse practitioner for a minor injury or a dentist for an oral injury. The worker is responsible for submitting a valid certificate or confirming that the medical provider will submit it.

Who should receive the claim?

Most Queensland employers are insured by WorkCover Queensland. Some larger employers are self-insured. The claim should be submitted to WorkCover Queensland or to the employer’s relevant self-insurer, depending on the employer’s insurance arrangement.

If you are unsure which insurer applies, the employer or the relevant official claim information may help identify the correct recipient. The WorkCover Queensland claim guide explains that not all employers are insured by WorkCover Queensland.

How do you lodge the claim?

WorkCover Queensland provides online, telephone and paper claim options. Follow the current instructions on its How to make a claim page. A self-insured employer will have its own process for receiving the claim.

Information commonly requested includes contact details, the employer’s name and location, the Work Capacity Certificate and details of what happened, when it happened and the injury or illness. Give information that is accurate and complete. If the employer reports the incident or assists with a form, that does not remove the need for the claim to be submitted to the appropriate insurer.

What information and evidence should you keep?

Keep copies of documents that may help explain what happened and how the injury or illness affects work. Depending on the circumstances, this may include:

the Work Capacity Certificate and later medical certificates or reports;
medical records, treatment referrals and receipts;
the date, location and description of the incident or the development of symptoms;
messages, emails or reports about the injury and communications with the employer;
payslips, wage information and employment records;
names and contact details for relevant witnesses; and
insurer correspondence, claim forms, decisions and requests for further information.

Keeping an organised record does not determine whether a claim is accepted. It can help the insurer and any adviser understand the factual and medical material relevant to the claim.

What time limits apply?

Current WorkCover Queensland guidance says a claim must be submitted either within six months of receiving a diagnosis for the injury or illness, or within 20 business days after a doctor, nurse practitioner or dentist first assesses the injury as causing total or partial incapacity for work.

Exceptions may apply in circumstances such as a genuine mistake, being away from Queensland or Australia, or another reasonable cause. An exception is not automatic. If a claim is submitted after the six-month period, the reason for the delay and supporting information may be required.

Prompt action can reduce uncertainty about which time limit applies and help preserve relevant records. The time limit for a statutory claim is separate from the requirements that may apply to a later common-law damages claim.

How does the insurer assess the claim?

The insurer considers the available facts and medical evidence and may contact the worker, employer, treating practitioners or witnesses. It may ask for further documents or medical information while assessing the claim.

WorkCover Queensland states that most claims are decided within 20 business days. If a decision takes longer, its guidance says the worker should be told that it is taking longer, given an explanation and provided with the reasons in writing. A worker who is unhappy with the reasons for the delay may ask the Workers’ Compensation Regulatory Service to review those reasons.

What support may be available if accepted?

If a statutory claim is accepted, WorkCover Queensland says it can usually pay reasonable treatment costs and part of a worker’s wages where a doctor says the worker cannot work because of the injury, or is working reduced hours while recovering. Recovery and return-to-work support may also be available.

The type and extent of support depends on the accepted claim, medical information, work capacity and the applicable rules. Acceptance of a statutory claim does not by itself establish a common-law damages claim.

What is the difference between a statutory claim and a common-law damages claim?

A statutory workers’ compensation claim is generally described by WorkCover Queensland as a no-fault claim for support such as reasonable treatment costs and part of lost wages, subject to the legislation and the insurer’s decision.

A common-law damages claim is separate. The worker generally needs to establish that the employer failed to provide a safe work environment or breached a duty of care, that this caused the injury and that the injury caused compensable loss. The official common-law guide also explains that a permanent impairment assessment and Notice of Assessment may be required, and that a notice of claim usually needs to be submitted within three years of the injury.

A common-law claim can affect the statutory claim and involves different evidence and procedural requirements. The Medical Assessment Tribunal guide provides related general information about medical assessment processes.

What if the claim is delayed or rejected?

If the decision is delayed, check the insurer’s explanation and any written reasons. WorkCover Queensland’s current guidance says a worker may ask the Workers’ Compensation Regulatory Service to review the reasons given for a delay.

If the claim is not accepted, read the written decision and the reasons carefully. The official WorkCover information includes a separate explanation of what happens when a claim is not accepted or is closed. The available options depend on the decision, the evidence and the applicable process; our separate guide on what happens after a claim is rejected or closed explains how written reasons and independent review generally work. Legal advice may assist with understanding a disputed issue, but a person does not need a lawyer simply to lodge the initial statutory claim.

When might legal advice assist?

Legal advice is not required for every statutory claim. It may assist where worker status or eligibility is disputed, the medical evidence is complex, the insurer’s decision is delayed or rejected, a person receives a Notice of Assessment or lump-sum offer, or the person is considering a common-law damages claim.

For a balanced explanation of those situations, read when a Queensland workers’ compensation lawyer may assist or the firm’s Queensland workers’ compensation information. Whether the firm can act depends on the circumstances and any written costs agreement.

Queensland source material

This guide is general legal education only. It is not legal advice and does not guarantee eligibility, acceptance or outcome. Queensland workers’ compensation rules and insurer processes may change, and the facts of an individual matter may affect the position.