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What is WorkCover and how do I claim?

By: Melinda Lovell

If you have suffered an injury in the course of your employment, whether physical or psychological, you are entitled to lodge a statutory claim for WorkCover benefits if your employer is insured under the state-based scheme. 

A WorkCover claim will be accepted if you can establish that:-

  • You are a worker; 
  • You have suffered a personal injury; and 
  • Your work was a significant contributing factor to your injury. 

What type of work injuries can I claim WorkCover for?

Each and every workplace injury is different and they don’t always happen in an instant. Some workers may suffer an injury over a period of time as a result of their duties. At Sciaccas Lawyers, we have assisted thousands of injured workers, including those whose injuries have arisen over a lengthy period of time in the course of their employment. This can include both physical injuries and psychological injuries like post-traumatic stress disorder.  

You may also claim for any pre-existing injury that has been aggravated in the workplace.

What is the Reasonable Management Action Exception?

For claims involving psychological injuries, it is also necessary to establish that the injury has not arisen out of reasonable management action taken in a reasonable way.  

The difficulty with psychological injuries is articulating the precise cause of the injury. More often than not, psychological injuries arise out of a series of events accumulated over a period of time. This ultimately allows WorkCover to utilise the exception of ‘reasonable management action’ in order to reject the claim.

It is important that injured workers do not list issues if they are not directly causative of their injury. This gives WorkCover less opportunities to reject the claim based on the reasonable management action exception. We strongly encourage injured workers to seek our advice and assistance in navigating this difficult area of law. 

What are the time limits for WorkCover claims?

Strict time limits apply to WorkCover claims, so it’s important to seek legal advice as soon as practical after your injury. A claim for compensation is generally only valid if lodged within six months after the date in which the worker is assessed by a doctor. 

This time limit may be waived if WorkCover are satisfied that the delay in lodging the application was due to mistake, absence from the State, or a reasonable excuse. 

Different time limits may apply if WorkCover make a decision to reject an application for medical treatment and hospitalisation. This decision must be appealed to the Industrial Magistrates Court within 20 business days after receiving the rejection notice. 

What happens if my WorkCover claim is rejected?

There are many reasons as to why WorkCover may reject claims. In some cases, it may be that WorkCover determined that the injury did not relate to your work. This could be due to incorrect information or lack of medical evidence provided. 

If your claim is rejected, you should seek legal advice immediately to determine if the decision can be overturned. Once you have received the ‘Reasons for Decision’ from WorkCover, you have three months to lodge a review to the Regulator.  

The following case study is an example of where we have acted on behalf of an injured worker with respect to reviewing a rejected WorkCover decision for a psychological injury.

Rejected WorkCover decision case study

In August 2020, Sciaccas Lawyers were contacted by an injured worker who had suffered depression and anxiety as a result of being bullied and harassed by colleagues in the workplace. WorkCover had rejected the claim stating that the bullying events could not be substantiated and that the injuries arose out of management action, conducted in a reasonable way.

Sciaccas reviewed this decision to the Worker’ Compensation Regulator. During this process, we sought clarification from our client’s General Practitioner as to the precise cause of the injury. This medical evidence clarified that the injury did not arise as a result of any management action, but instead, the bullying and harassment directly from the worker’s colleagues.

We gathered further witness statements and policies to substantiate that our client had been subject to bullying behaviour in the workplace over a period of time, which caused our client’s mental health to decline significantly.

The Regulator accepted our submission that the medical evidence indicated that the injury related solely to interactions with our client’s colleagues, and did not arise out of management action. Therefore, our client’s claim could not be excluded under the ‘reasonable management exception’ and was considered as one for acceptance.

How much will it cost to review?

Sciaccas Lawyers will provide you with a free legal consultation to discuss your claim. We will also provide an estimate of legal costs as well as the relevant time frames that will apply to your claim. 

If we determine you have reasonable prospects of success, Sciaccas Lawyers may decide to act for you on a ‘no win, no fee’ basis. 

If a WorkCover claim is accepted, you are entitled to receive payments for time off work and for medical expenses until their injury is deemed to be ‘stable and stationary’. Should any worker have any queries regarding the services we provide, they should not hesitate to call us on 07 3867 8888 or contact us online.