Tips for making a WorkCover claim
Queensland Teachers' Journal, Vol 129 No 6, 23 August 2024, page 27.
Understanding how to make a WorkCover claim is crucial to accessing treatment and getting on the path to recovery. This article provides teachers with guidance on navigating the process of making a WorkCover claim after being injured at work.
See your general practitioner ASAP
There are time limitations for making a claim. Typically, a claim for workers’ compensation must be made within six months of the date of injury. This means that sometimes “waiting and seeing” whether your injury or illness gets better can be a risky decision. Our advice to teachers is that if your doctor has formed a view that you have a condition that is impacting your ability to work, a WorkCover claim should be considered sooner rather than later.
At your appointment, you will need to request a “work capacity certificate, which will provide WorkCover with the essential information pertaining to your injury, such as:
- the nature of your injury
- the date your injury was sustained – for the reasons set out above, it is important your doctor records this date accurately
- the date you were assessed by your doctor
- your capacity for work as a result of the injury.
Submit your claim
Your GP can submit the claim for you. Alternatively, you can submit your claim online or by calling WorkCover on 1300 362 128.
WorkCover will contact your school as part of the assessment of your claim. It is advisable to complete an incident report or MyHR record so your school has a record of your injury.
Specific considerations for psychological injury claims
In Queensland, a claim for psychological injury can be rejected if WorkCover determines that a worker’s injury has been significantly caused by “reasonable management action taken in a reasonable way”.
The courts have defined “reasonable management action” very widely. Typically, reasonable management action will include:
- any performance management processes
- management of workloads and resourcing considerations
- supervision and management of staff by a principal or other executive leadership team member (including decisions about how to respond to student behaviour).
This means that if any of these factors are determined to be significant contributing factors to the development of a workplace injury, there is a prospect of the claim being denied.
We therefore encourage teachers to focus their application to WorkCover on non-management factors that have contributed to their injury, e.g. student behaviours directly, rather than any management response.
Waiting for a claim decision
After you have submitted your claim, WorkCover has 20 business days to make a decision. For some complex claims (e.g. claims concerning psychological injury arising over a lengthy period of time), it can take longer for WorkCover to decide.
During this time, you will be responsible for paying your own medical and treatment costs. However, you should keep receipts for all costs incurred, as these can be submitted for reimbursement once your claim is approved.
Extra tip: WorkCover can approve some treatment for psychological injuries if claim applicants require assistance while their claim is being determined.
Receiving a claim decision
WorkCover typically provides its decision via email or SMS.
If your claim is accepted, WorkCover may be able to pay for your medical and treatment costs, as well as making weekly payments to compensate for time off work to recover.
If your injury requires surgery, the timeframe for appealing against a rejection is very short. So please contact the Union early for assistance if you have difficulty having surgery approved.
If your claim has been rejected, WorkCover will outline the reasons why. If you disagree with the outcome determined by WorkCover, you should contact your Union for further assistance.