WorkCover FAQs

Here are some FAQ's that will help you understand what you need to do as an employer in relation to Workers' Compensation and where you can find more information. Don't forget you can call CCIQ on 1300 365 855 during Brisbane business hours and talk with a member of our Workers' Compensation team who can assist you with workers' compensation advice.

Do I need a WorkCover policy?

If you have a business in Queensland and employ workers, you are required by law to insure them against workplace accidents with WorkCover Queensland. For more information visit: https://www.worksafe.qld.gov.au/insurance/which-insurance-product-is-right-for-you

What are my responsibilities as an employer if an employee is injured at work?

If an incident/accident has occurred at work, depending on the severity you may need to notify WHSQ (Workplace Health and Safety Queensland). For more information visit: https://www.worksafe.qld.gov.au/injury-prevention-safety/incidents-and-notifications/notify-of-an-incident

You have a legal responsibility to notify WorkCover Queensland immediately of an injury for which compensation may be payable. You should contact them and lodge a report as soon as you know the details of your workers injury. It is then the workers decision to make a claim. If a claim is lodged, a WorkCover claims advisor will make contact and get details to ascertain whether the claim will be approved or not. Depending on the injury nature and severity, there may be restricted duties or hours, and your employee and insurer can advise you on what your obligations are. More info (link) https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/what-happens-after-a-claim-is-made. There are also certain rights and responsibilities for all parties. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/rights-and-responsibilities

What are my responsibilities if the claim is accepted?

If the claim is accepted, you should take every reasonable step to cooperate and participate with rehabilitation and suitable duties and keep WorkCover informed about your worker's progress in returning to work. This assists WorkCover to get your worker back to work as quickly and safely as possible. You will need to pay an excess on any accepted claim if your worker has taken time off from work due to their injury. This excess will be the lesser of:

100% of Queensland full-time adult's ordinary time earnings (QOTE), or the injured worker's weekly compensation rate.

You should also notify WorkCover if you pay any claim expenses, so they can reimburse you for them. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/rights-and-responsibilities

What are my rights as an employer with a claim?

It's your right to raise any concerns with your claims representative or customer advisor throughout the duration of the claim. This may include disputing the claim, or any decisions WorkCover make about the claim. If WorkCover have made a decision or taken action that you don't understand, please discuss these with them so they can help you with your concerns.

If you feel your dispute, or any other issues you've raised with WorkCover, have not been resolved to your satisfaction, you can make an official complaint. If you disagree with a decision that WorkCover have made, you can seek a review with the Workers' Compensation Regulator. Call WorkCover if you have any questions about your rights and responsibilities in Queensland.

Do I need to contact Workplace Health and Safety Queensland (WHSQ)?

If an incident has occurred at work, depending on the severity you may need to notify WHSQ. For more information visit: https://www.worksafe.qld.gov.au/injury-prevention-safety/incidents-and-notifications/notify-of-an-incident

How is a claim approved or denied?

WorkCover gathers information from the worker, employer, doctors and other people, such as witnesses to the event or independent medical examiners, to help them make a decision. The onus is on the person who makes the claim to prove their claim. Once WorkCover has gathered enough information to decide on the claim, both the worker and the employer will be informed on the decision. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/what-happens-after-a-claim-is-made

What is a journey claim?

A journey claim is when an injury occurs between your home and your place of work. It may also include a journey between your home or workplace and a place of trade or training as part of your work. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/what-happens-after-a-claim-is-made/journey-claims

What is a suitable duties plan?

If a worker is unable to return to their normal duties, WorkCover will develop a suitable duties plan to help them stay at, or return to work quickly. A suitable duties plan takes into account the worker's current work capacity, medical advice and individual situation. Sometimes your business won't have appropriate suitable duties available and in these instances, WorkCover may find a host placement with a host employer. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/stay-at-work-return-to-work/how-to-return-to-work/suitable-duties-plan

What if I can’t provide suitable duties for my injured employee?

As an employer, you have a responsibility to take all reasonable steps to help with, or provide, rehabilitation to a worker suffering a work-related injury, while they are receiving compensation. This includes, where required, placing an injured worker on suitable duties. WorkCover may be able to find a host placement with a host employer on your behalf, but otherwise – unless you are able to place an employee on suitable duties – you may need to pay the employee to remain away from work. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/stay-at-work-return-to-work/how-to-return-to-work/suitable-duties-plan

Can I get a review conducted of a decision or appeal a decision?

If you're unhappy with a decision on a claim, you can appeal the decision through the Workers' Compensation Regulator. The Workers' Compensation Regulator is an independent entity and is not part of WorkCover Queensland or a self-insurer. It is an independent decision maker who forms part of the Workers' Compensation and Policy Services, Office of Fair and Safe Work Queensland, Department of Justice and Attorney-General. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/reviews-and-appeals

How do I go about having a claim reviewed?

A review must be lodged with the regulator within 3 months of receiving the insurers written decision and should contain all supporting information with the application. Employers should use the 3 months wisely and gather as much information as possible to include in the review. Claims can be lodged outside the 3 months but must include reasons for it being lodged outside the timeframe.

A claim form (Form 642.3) and further information can be obtained online at https://www.worksafe.qld.gov.au/rehab-and-claims/reviews-and-appeals/what-you-need-to-know-about-a-review.

What are grounds for review?

Grounds for review must be provided and must be relevant to the injury and the claim e.g. the insurer did not consider all of the relevant medical information; the applicant can then attach appropriate materials such as a new medical report, investigatory information etc. The grounds are the reasons in the applicants words as to why they believe the insurers decision is wrong. Reviews are conducted by the Workers Compensation regulator who are independent to the parties. The Workers Compensation Regulator cannot review an Insurers procedure or the way in which they managed the claim and any grounds must be detailed and relate specifically to the injury and claim. Information you provide during a review may also be provided to the injured worker. The regulator should have completed a review within 25 business days of receipt of a review. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/faqs/reviews-and-appeals

What are the possible outcomes of a review?

The review decision will either confirm the original decision, Vary the original decision, or set aside the original decision and substitute another decision.

What happens if I am unhappy with a review decision?

If you are unhappy with a review decision, the next step is for you to consider the value of lodging an appeal of the review decision. If you decide to appeal you must lodge an appeal with the Queensland Industrial Relations Commission (QIRC) against the workers’ compensation regulator. The appeal must be filed within 20 business days of receiving the workers compensation regulators decision.

How do I lodge an appeal?

Workers and employers who are dissatisfied with a Workers' Compensation Regulator claim review decision can appeal to the Queensland Industrial Relations Commission (QIRC) within 20 business days of receiving the decision. The Workers' Compensation Regulator defends its review decisions in the Commission. On receipt of the Appeal a Workers' Compensation Regulator appeals officer is allocated to manage the case. You can contact the appeals officer at anytime to ask questions or discuss the case with them. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/reviews-and-appeals/appeal-a-review-decision-employers/appeal-a-review-decision-on-a-claims-matter-a-step-by-step-guide-for-employers

Who do I need to speak to about a claim?

You should speak with WorkCover Queensland as your insurer about the specifics of your particular claim.

What is a common law claim?

Under the Queensland workers' compensation scheme, workers have the right to sue their employer for negligence through a common law or damages claim.  Recent changes to the workers' compensation legislation, that came into effect from 15 October 2013, limit this right to workers with more serious injuries (more than 5 per cent degree of permanent impairment). If the worker is able to prove negligence, a lump sum payment of damages is awarded to the worker taking into account their future economic loss (loss of wages) and pain and suffering. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/common-law-claims

How do I get a copy of a prospective employees WorkCover claim history?

Section 571D of the Workers' Compensation and Rehabilitation Act 2003 entitles an employer to obtain a copy of a prospective worker's compensation claims history summary by applying to the Workers' Compensation Regulator. The claims history summary states the number and nature of a person's current or previous applications for compensation or claims for damages under the Queensland workers' compensation scheme. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/making-a-claim/apply-for-a-claims-history-summary.

If you have received a workers claim history for a prospective employee you must not do any of the following;

  • Disclose to anyone else the contents of, or information contained in the summary
  • Give access to the document to anyone
  • Use the information contained in the summary for any purpose other than for a process for considering and selecting a person for employment
Do I need to appoint a rehabilitation and return to work coordinator (RRTWC)?

Employers who pay annual wages of more than $7,124,520 (5200 times QOTE) for the preceding financial year, or are in a high risk industry with wages of more than $3,562,260 (2600 times QOTE), must appoint a rehabilitation and return to work coordinator (RRTWC). For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/return-to-work-support/employers-obligations

What will WorkCover pay in a claim?

If a claim is accepted, WorkCover will cover the cost of approved and reasonable medical treatment related to the injury. The worker must provideWorkCover with a workers' compensation medical certificate to ensure medical treatment and compensation is paid while they are injured. If the worker withdraws their claim, or elects to halt their claim at the reporting stage of claim determination (so the claim is registered for report purposes only), then payment for treatment is the responsibility of the worker.

WorkCover will only approve treatment provided by a registered or non-registered approved provider. The table of costs for your claim lists these providers. The Act uses the term 'registered', to refer to those professions covered by a health registration board. A scheduled fee exists for most services however some are 'fee by negotiation'. These services must be approved by WorkCover before you proceed with treatment. For more information visit: https://www.worksafe.qld.gov.au/service-providers/working-with-us

What are Medical Assessment Tribunals and what are they used for?

Medical assessment tribunals are set up to provide independent, expert medical decisions about injury and impairment sustained by Queensland workers. The tribunals are made up from an independent panel of specialist doctors. Doctors may apply to be on the panel but are only appointed to the panel if they can demonstrate a high level of knowledge, expertise and experience. Medical assessment tribunals are held at the Workers' Compensation Regulator's offices.

A referral to the medical assessment tribunals may be required if there are conflicting medical opinions in relation to whether employment has been a significant contributing factor to the injury of whether there is an ongoing incapacity for work as a result of a work injury.

The medical assessment tribunals may also be required to assess any degree of permanent impairment resulting from an injury. This includes the degree of permanent impairment resulting from disfigurement associated with an injury. Only an insurer can make a referral to a medical assessment tribunal. The insurer should inform the worker that a matter is to be referred to a medical assessment tribunal before sending the referral paperwork to the Workers' Compensation Regulator for processing.

A worker attending a medical assessment tribunal will be seen by between three and five specialist doctors depending on the nature of their injury. The tribunal members will be specialists in the relevant field of medicine and independent of the insurer. The Tribunal Secretariat will make every effort to ensure that the doctors on the tribunal have no prior association with the worker. For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/medical-assessment-tribunals

How are my WorkCover premiums calculated?

Premiums are calculated differently depending on whether your wages are higher or lower than $1.5 million.

For employers who pay more than $1.5 million in wages

Your WorkCover accident insurance policy premium is calculated using a wages multiplied by rate formula, called experience based rating. You pay your premium provisionally—that is, you pay for your insurance at the beginning of a period, and adjust it at the end. Your rate is influenced by a number of factors, including:

  • your claims performance
  • your industry’s claims performance
  • your size relative to your industry.

Using your estimated wages for the current financial year, WorkCover will calculate your provisional premium. If you’re renewing your policy, WorkCover use your actual wages for the past financial year and calculate your actual premium. When you renew your policy, WorkCover subtract the provisional premium you’ve already paid for the past financial year from your actual premium for that year. Then WorkCover add your provisional premium for the current financial year. GST and Stamp Duty are applied to all policies to reach your final premium amount.

Simplified premium model for employers who pay $1.5 million or less in wages

WorkCover has introduced a simplified premium model for employers who pay $1.5 million or less in wages. This new model is based on a claims performance rating and protects these employers from large variances in premium costs that can occur by expensive one-off claims. Employers can only move 1 rating category above or below their current rating from year to year. This caps annual variances in premium rates at 10% which provides stability for these employers and makes it easier to more accurately budget for premium costs.

Premium category  Premium rate

  • Rating 1  80% of Industry rate
  • Rating 2   90% of Industry rate
  • Rating 3  100% of Industry rate
  • Rating 4  110% of Industry rate
  • Rating 5  120% of Industry rate

Note:  Most employers below 80% of IR will receive a 5% premium rate reduction for the 2014–2015 year

New employers will start at Rating 3

Employers above Rating 5 will be reviewed on a case by case basis.

From 2015–2016 onwards

Category ratings will be based on an employer's claims experience relative to the industry experience for the preceding financial year

Claims experience will include statutory and damages claims costs paid in the financial year

The first $500 of an employer's total claims costs for the previous financial year will not be included in their claims experience

Employers can only move a maximum of one category (up or down) each year regardless of their actual claims experience in that year.

For more information visit: https://www.worksafe.qld.gov.au/insurance/which-insurance-product-is-right-for-you/accident-insurance/calculating-premium 

What if I believe there is fraudulent activity involved in the claim?

Your first point of contact should be your claims advisor with WorkCover Queensland as your insurer. Some things that may occur in this instance is independent medical assessments or the use of private investigators depending on the circumstances.

What Legislation applies in Queensland?

The legislation that applies is the Workplace Health and Safety Act 2011 https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/W/WorkHSA11.pdf, the Workplace Health and Safety Regulations 2011 https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/W/WorkHSR11.pdf and the Workers Compensation and Rehabilitation Act 2003 https://www.legislation.qld.gov.au/legisltn/current/w/workerscompa03.pdf.

What are some ways I can reduce my premium?

You can positively impact your premium and reduce costs by:

  • Prevention is better than cure – keep your workplace safe
  • Make a claim as soon as possible
  • Work with your insurer (WorkCover) and support your worker to recover at work or return to work quickly
  • Promote an injury prevention culture in the workplace
  • Be return to work focused and have suitable duties available immediately, as this can reduce the risk of common law.
Small business specific information?

The Worksafe website contains specific information to assist small businesses. This includes information on who needs a policy, injuries at work, health benefits of work, premium information as well as other useful links. Visit https://www.worksafe.qld.gov.au/forms-and-resources/small-business for more information.

Contact numbers and websites

WorkCover Queensland Phone 1300 362 128. www.Worksafe.qld.gov.au

Workers Compensation Regulator – Reviews and Appeals unit, phone 1300 739 021. www.Worksafe.qld.gov.au

Workplace Health and Safety Queensland – reporting incidents (ask for inspector), phone 1300 362 128. www.Worksafe.qld.gov.au

Office of Fair and Safe Work Queensland –  phone 1300 369 915.  http://www.justice.qld.gov.au/corporate/about-us/fair-and-safe-work-queensland

Timelines

To lodge claim 
Within 6 months from date of injury (if lodged more than 20 days after injury, may be approved from date of lodgement)

To approve/deny claim
Within 20 business days from receipt of claim

To request review
3 months of receiving an insurers decision

Who is Who?

WorkCover Queensland is the main provider of workers’ compensation insurance to Queensland employers and manages the claims of those employees. They are your insurer and should be your first point of contact in relation to a workplace injury or illness. https://www.worksafe.qld.gov.au/

Licensed self-insurers are Queensland employers who have met legislative requirements and obtained a self-insurance licence. These employers are referred to as a self-insurer and the self-insurer manages their own workers’ compensation claims. https://www.worksafe.qld.gov.au/insurance/self-insurance-auditing

The Workers’ Compensation Regulator oversees the Queensland workers’ compensation system and runs the review and appeals unit, administers medical assessment tribunals and monitors compliance and licensing issues. The Workers’ Compensation Regulator is also committed to supporting Return to Work Coordinators and employers through a range of education initiatives including webinars and conferences. The Workers’ Compensation Regulator is part of the Queensland Government Department of Justice and Attorney-General which also oversees work health and safety and electrical safety in Queensland. https://www.worksafe.qld.gov.au/about-us

What are high risk industries?

Industries are categorised in this schedule using a system known as the Australian and New Zealand Industrial Classification (ANZSIC). An industry stated in column 2 has the ANZSIC class stated in column 1

Agriculture, forestry and fishing

  • 01  Agriculture 
  • 02  Aquaculture 
  • 03  Forestry and logging 
  • 04  Fishing, hunting and trapping 
  • 05  Agriculture, forestry and fishing support services 

Mining

  • 06  Coal mining 
  • 07  Oil and gas extraction 
  • 08  Metal ore mining 
  • 09  Non-metallic mineral mining and quarrying 
  • 10  Exploration and other mining support services Manufacturing 
  • 11  Food product manufacturing 
  • 12  Beverage and tobacco manufacturing 
  • 13  textile, leather, clothing and footwear manufacturing
  • 14  Wood product manufacturing 
  • 15  Pulp, paper and converted paper product manufacturing 
  • 16  Printing (including the reproduction of recorded media) 
  • 17  Petroleum and coal product manufacturing 
  • 18  Basic chemical and chemical product manufacturing 
  • 19  Polymer product and rubber product manufacturing 
  • 20  Non-metallic mineral product manufacturing 
  • 21  Primary metal and metal product manufacturing 
  • 22  Fabricated metal product manufacturing 
  • 23  Transport equipment manufacturing 
  • 24  Machinery and equipment manufacturing 
  • 25  Furniture and other manufacturing  

Construction 

  • 30  Building construction 
  • 31  Heavy and civil engineering construction 
  • 32  Construction services 

Transport and storage 

  • 46  Road transport 
  • 47  Rail transport 
  • 48  Water transport 
  • 49  Air and space transport 
  • 50  Other transport 
  • 52  Transport support services 
  • 53  Warehousing and storage 

Health and community services 

  • 84  Hospitals 
  • 85  Medical and other health care services 
  • 86  Residential care services 

Miscellaneous 

  • 29  Waste collection, treatment and disposal services 
  • 77  Public order, safety and regulatory services 
  • 0510  Forestry support services 
  • 7711  Police services 
  • 1611  Printing 
  • 3020  Non-residential building construction 
  • 7714  Correctional and detention services 

 

For more information visit: https://www.worksafe.qld.gov.au/rehab-and-claims/injuries-at-work/high-risk-industries