Claiming Workers' Compensation Benefits
As a worker you are entitled to claims Workers Compensation Benefits as a result of a Work Related Injury
Reporting an Injury
Any injury should be reported as soon as possible, usually to your supervisor (Leading Hand, Team Leader, Section Manager). When the injury, or the effects of injury, occur away from work or prevent you starting work, you must report the injury in the same way as if it had happened at work.
If you are injured at work you must fill in the 'Register of Injuries' or 'Accident Report Form' kept in your workplace.
Injured workers should consult their nominated treating doctor (a doctor of their own choice) and obtain a completed WorkCover Certificate.
The OHS Regulation (Clause 38) requires you to report health and safety issues to the company so that something can be done to remove or fix the problem.
Section 23 of the OHS Act 2000 sets out 'whistleblower protection' which protects you from being discriminated against for reporting injuries or raising OHS concerns in your workplace.
Reporting to the Insurance Company
A Workers Compensation claim is now driven by notification of injury, not necessarily the completion of a claim form. On notification of an injury, the company is required to report the incident and the nature of the injury to the insurance company.
If the injury is a significant injury that prevents you from performing your normal duties for more than seven consecutive days (as evidenced by a Doctor's certificate) the insurance company must be notified within 48 hours and a WorkCover notification made (Section 267(1) WIM).
For any other injury the insurance company must be notified within seven days.
One of the most important things about the early notification process is that the injury management process is to commence as soon as the injury is notified.
Starting Entitlements - Provisional Liability
Insurance companies and self insurers MUST now being paying claims for weekly compensation within seven days after receiving an initial notification. This is known as Provisional Liability. That means, within seven days of the company telling the insurance company about your injury, you must be paid, unless there is a 'reasonable excuse' not to pay.
There is a presumption that provisional benefits should be paid. The Insurance Company should provide the company with a notification number. This number will often become the claim number.
The company must provide a Workers Compensation claim form if you request one.
The only 'reasonable excuse' which an insurer or self-insurer can have for not paying a claim straight away is one of the following:
* The insurer is unable to contact the worker
* There is insufficient medical evidence
* The injured worker is not an employee
* Worker refuses to sign privacy clause on claim form
* Injury is not work related
* Injury is notified after two months
* Injury is not significant
Under Provisional Liability
* Weekly compensation payments for up to 12 weeks from the date of incapacity can be made
* The length of time approved on provisional liability payments will depend on the nature of the injury and how long the person is likely to be off work
* The payments do not mean acceptance of ongoing liability, but serve to avoid unnecessary administrative disputes and get the ball rolling in relation to treatment and injury management
* Medical and treatment expenses up to $5,000 can be approved
If the insurance company refuses to make provisional weekly payments of compensation or medical expenses you may seek an interim payment direction from the Workers Compensation Commission.
There is a presumption in the Commission that these interim payment orders should be ordered. These matters are expedited so that the injured worker gets their entitlements quickly.
Investigation
Investigating an injury or illness is part of the risk management process. The purpose of investigation is to prevent future injuries, not to lay blame on the individuals involved.
The company's insurer will also undertake an investigation for Workers Compensation purposes to assist in determining liability for a claim, although, the investigation will not affect the commencement of entitlements.
If, once provisional liability has been accepted, the investigation finds a reason why the company is not liable to pay compensation, the claim can be declined and payments stopped. If this happens you can refer the matter to the Commission for conciliation.
Restrictions on Bringing Claims
There are time restrictions for bringing a claim for compensation. Notice of injury must be given to the company as soon as possible and before voluntarily leaving employment (Section 253 WIM). Failure to do this does not prevent you from claiming compensation as special circumstances apply (Section 254 WIM).
There are time limits for making a claim (Section 261), generally six months after the injury or accident happened or in special circumstances up to three years.
Injured members should contact the
You must report an injury as soon as possible and if practicable before you leave the workplace
You must fill in a form contained in the Register of Injuries, check with your Supervisor or Union Delegate
You must report all potential hazards
A Workers Compensation claim is now driven by notification of injury
On notification of an injury, the company is required to report the incident and the nature of the injury to the insurance company
The injury management process is to commence as soon as the injury is notified
Insurance companies and self-insurers MUST now being paying claims for weekly compensation within seven days after receiving an initial notification
Under provisional liability, weekly compensation payments for up to 12 weeks from the date of incapacity can be made
Investigating an injury or illness is part of the risk management process
There are time limits for making a claim, generally six months after the injury or accident happened, or in special circumstances, up to three years.
