WorkCover Claims for Employers in Queensland

Has your organisation received a WorkCover Queensland claim from a worker? You may need advice on how to respond, the prospects of the claim and your options if you disagree with a decision. Employer Services Legal provides legal advice for employers, assists with preparing responses to WorkCover Queensland and provides representation for review applications and appeals.

With the exception of self-insurers, WorkCover Queensland is the exclusive provider to Queensland employers of accident insurance for workers who have suffered work-related injuries. The Workers’ Compensation and Rehabilitation Act 2003 (Qld) (‘WC Act’) provides the framework for managing workers’ compensation and rehabilitation in Queensland including the ability for workers to make a WorkCover claim.

When preparing an employer response to a WorkCover claim, consider the following steps:

The WorkCover claim process generally comprises the following steps:

A worker who has suffered an injury must complete a Claim Form and obtain a Work Capacity Certificate (‘WC Certificate’) from their treating doctor and then provide these to WorkCover Queensland (or self-insurer). A WC Certificate can also be completed by a nurse practitioner for a minor injury or a dentist for an oral/dental injury.

The worker should also notify their employer of the claim, preferably by providing a copy of the Claim Form and a copy of the WC Certificate. The Claim Form has a section for both the worker and the employer to complete so the form can be submitted to WorkCover Queensland either jointly or separately.

An employer also has an obligation to report an injury immediately or within eight business days of becoming aware of the injury unless there is a reasonable excuse. Examples of a reasonable excuse include that the employer has not been reliably informed about the injury, there is evidence that the injury was not sustained in the course of the employment, or there is a technical or other issue that led to a short delay in reporting within the time frame.

In practice, this requirement to report tends to be applied when an employer knows a worker has sustained an injury for which workers’ compensation may be payable under the WC Act but the worker does not notify WorkCover Queensland (or self-insurer).

Unless the worker and the employer have already jointly submitted the Claim Form to WorkCover Queensland, then WorkCover Queensland will contact the employer to obtain a response. This response can be provided by completing the employer section of the Claim Form or via WorkCover Queensland’s online services.

WorkCover Queensland is required to make a decision within 20 business days after the application has been made. However, in practice a decision may not be made within this time frame if there is an inability to obtain information.

WorkCover Queensland (or self-insurer) will then either accept or reject the claim. A dissatisfied party may ask for a reasons for decision within 20 business days of being advised of the decision.

An employer (or worker) may lodge an application for review with the Office of Industrial Relations (‘OIR’) within 3 months of receiving the reasons for decision from WorkCover Queensland (or insurer). A party lodging a review is known as the applicant.

The OIR Review is an impartial administrative review conducted by a Review Officer of the OIR. It is not a court process. An applicant may elect to have a right of appearance before the Review Officer.

The Review Officer will endeavour to make a decision within 25 business days of the review application being lodged unless an extension has been granted or to comply with the requirements of procedural fairness.

The potential decision outcomes of a review will be to confirm, vary, set aside and substitute another decision or set aside the decision and return the matter to WorkCover Queensland with directions considered appropriate.

A party who is dissatisfied with the review decision can lodge an appeal with the Queensland Industrial Relations Commission (‘QIRC’) within 20 business days of receiving the decision.

Where an employer lodges an appeal, the OIR will defend the review decision on behalf of the Workers’ Compensation Regulator (being the respondent). Where a worker lodges an appeal, the OIR will manage the defence of the review decision on behalf of the Workers’ Compensation Regulator (being the respondent) in the QIRC.

The appeals process involves a de novo hearing whereby a completely new trial or review is undertaken. The QIRC will have an initial conference and if still unresolved then proceed to a hearing.

The potential decision outcomes of an appeal will be to confirm, vary, set aside and substitute another decision or set aside the decision and return the matter to the respondent with directions considered appropriate.

Yes. An employer can provide a response disputing the claim through the employer section of the Claim Form or WorkCover Queensland’s online services. If dissatisfied with WorkCover Queensland’s decision, an employer may apply for an OIR review within 3 months of receiving the reasons for decision.

Yes. A dissatisfied party may ask for a reasons for decision within 20 business days of being advised of the decision.

No. An OIR review is an impartial administrative review conducted by an OIR Review Officer. An applicant may elect to have a right of appearance before the Review Officer.

Yes. A party dissatisfied with the review decision can lodge an appeal with the QIRC within 20 business days of receiving the decision. The appeal involves a de novo hearing, whereby a completely new trial or review is undertaken. The QIRC will hold an initial conference and, if the matter remains unresolved, proceed to a hearing.