WorkCover FAQs

FAQs on what employers need to do in relation to Workers' Compensation, and where to go for more information.

If you need further assistance with workers' compensation advice, call CCIQ on 1300 365 855 during business hours from 8:30am to 5:00pm (AEST) Monday to Friday and talk with a member of our Workers' Compensation team.

Further resources

Case study - Manufacturing industry

Case study - Hospitality industry 

 

General process from business inception through to an injury and the claims process

 Workcover process

 

1.     Starting a business, and taking out WorkCover insurance:

  • When you start up a business, you will need to take out insurance to insure your workers against work-related injury or illness (unless you’re a self-insurer).
  • Work-related injuries can include physical injuries, psychological disorders, diseases, or even death. They can occur while at work, travelling to or from work, or whilst on a break at work.

What type of insurance policy do you need?:

Visit this link for further information on types of WorkCover insurance: https://www.worksafe.qld.gov.au/claims-and-insurance/workcover-insurance/types-of-insurance

  • If you are a director, partner of a partnership, sole trader or trustee, you won't be covered by an Accident Insurance Policy. If you fall into this category, you should also look to take out Workplace Personal Injury Insurance for yourself.

Visit this link for further information: https://www.worksafe.qld.gov.au/claims-and-insurance/workcover-insurance/types-of-insurance/workplace-personal-injury-insurance

How is your insurance premium calculated? (Accidence Insurance Policy):

  • The cost of the insurance policy will be dependent on:
    • the amount your business pays in wages;
    • your claims experience (the cost of any injury claims against your business); and
    • the industry you operate in.
  • When taking out a new insurance policy:
    • You will need to declare to WorkCover Queensland (WCQ) your estimated wages for the current financial year, and WCQ will then advise how much you need to pay for insurance.
  • If you are renewing an existing insurance policy:
    • You will need to private information to WCQ on your wages for the preceding financial year + your estimated ages for the current financial year, and WCQ will then advise how much you need to pay for insurance.
  • There are a number of ways you can lower the cost of your insurance premium, including improving safety in your workplace. Refer to step 4 below for further information on this.

 

2.     Understanding who needs to be covered under the WorkCover insurance:

The next step is understanding who needs to be covered under the WorkCover insurance for your business – this means you need to understand who is considered a 'worker' in your business.

Who is a worker?

  • TheWorkers' Compensation and Rehabilitation Act 2003 (Qld) (WCRA), defines a worker as a person who:
    • is an individual (not a corporation, partnership or trust, however sole traders may be considered workers);
    • works under a contract; and
    • is an employee for the purpose of assessment for PAYG withholding under the Taxation Administration Act 1953 (Cth), schedule 1, part 2-5.
  • Someone who works under a ‘contract of service’ like a sub-contractor or a labour hire worker may also be considered a worker under the WCRA.
  • Even if a contractor or sub-contractor has their own ABN, if they are working under a ‘contract of service’ they are still considered a worker.
  • Unpaid interns are also considered workers. An unpaid intern is any person who is carrying out work to gain practical experience or obtain a qualification, but who is not being paid.  (A school student, volunteer from a NFP, or vocational placement are not considered unpaid interns).

 

3.     Appointing a rehabilitation and return to work coordinator:

Not all businesses are required to appoint a rehabilitation and return to work coordinator (RRTWC).

What do you need to appoint an official RRTWC?

  • The Workers' Compensation and Rehabilitation Regulation 2014 (Qld) sets the following criteria for businesses in appointing a RRTWC:

(a)    for an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE;

(b)    otherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.

For further information on QOTE figures, visit: https://www.worksafe.qld.gov.au/laws-and-compliance/workers-compensation-laws/guidance-materials/workers-compensation-benefits-including-qote/what-is-qote

What if you don't meet the above criteria?

  • Even if you don't meet the above criteria, you can still appoint a RRTWC for your business.
  • Alternatively, if you do not meet the criteria and do not have an official appointed RRTWC – you should ensure there is another suitably competent and qualified staff member who is appointed to manage the rehabilitation and return to work process for any injured workers.

What training and skills does a RRTWC require?

  • Employers are responsible for ensuring that their appointed RRTWC (or other staff fulfilling these duties) are adequately skilled and trained to support injured workers.
  • It is not compulsory for a RRTWC to go through a specific training course to acquire these skills, however there are approved courses available, and this is an option which will help to ensure a RRTWC is competent for the role.

For further information, visit: https://www.worksafe.qld.gov.au/licensing-and-registrations/rehabilitation-and-return-to-work-coordinator-training/training-courses-for-rrtwcs

 

4.     Steps to prevent workplace injury and illnesses:

Once you have your insurance sorted, it is important to turn your mind to proactive steps which you can take to prevent workplace injury and illnesses in your workplace.

What steps should you take to prevent workplace injury and illnesses?

Depending on the type and size of your business, the following steps and strategies may be a good place to start:

  • Conduct a WHS risk assessment of your business, operations, and workplace.
  • Decide what WHS documentation, policies, procedures, and instructions are needed.
    • For example, this may include a WHS Policy, WHS Management Plan, Safe Work Procedures, COVID Safe Plan, Emergency Response Procedure and Evacuation Plans, Alcohol and Other Drug Policy, Risk and Incident Management Procedures, Rehab and Return to Work Procedure.

For further information and guidance, please visit: https://www.worksafe.qld.gov.au/safety-and-prevention/creating-safe-work/establishing-policies-and-procedures

  • Write / prepare the required WHS documentation, policies, procedures, and instructions. Ensure you think about how these will be practically implemented in the workplace.
  • Train and induct your workers on all WHS documentation, policies, procedures, and instructions,AND ensure you keep training and induction records!
    • In the event of a workplace accident or injury, it will be important to show that you have provided adequate induction and training for your workers.
    • Ensure your workers have the required PPE and other relevant equipment to safely carry out their duties.
    • Ensure your workers have the required skills, qualifications, and experience to safely carry out their duties.
    • Ensure you regularly monitor and review all of the above!

For further information visit: https://www.worksafe.qld.gov.au/safety-and-prevention/creating-safe-work

 

5.     What to do when an injury occurs:

What steps should the employer take if one of their workers experiences a work-related injury or illness?

  • Contact the worker as soon as possible.
  • Ensure the details of the injury / incident are recorded.
  • Advise WCQ about the injury.
    • Employers must notify WCQ of a work-related injury or illness within eight days of becoming aware of it.
    • Employers must report the injury to WCQ even if the involved worker doesn't make a claim.
    • WCQ will require the following details: worker's full name, worker's DOB, worker's contact information, your insurance policy number or ABN, brief details on the injury.
    • Note – reporting an injury to WCQ is not the same as making a claim.
  • In certain circumstances, you may need to notify Workplace Health and Safety Queensland (WHSQ) of a work-related injury or illness.

For further information and guidance, please visit: https://www.worksafe.qld.gov.au/safety-and-prevention/incidents-and-notifications/notify-us-of-an-incident/notify-workplace-health-and-safety-queensland-or-electrical-safety-office/confirm-if-an-incident-is-notifiable

  • Work with the worker to start planning their return to the workplace.

For further information, visit https://www.worksafe.qld.gov.au/claims-and-insurance/work-related-injuries/injury-or-illness-first-steps

 

6.     Dismissing an injured worker:

Can you dismiss an injured worker?

  • You cannot dismiss a worker who has suffered a work-related injury or illness within 12 months of the work-related injury or illness occurring.
  • If you do not allow and facilitate the injured worker to return to work (when safe to do so, and approved by the relevant medical practitioner), the worker may go to the Industrial Commission to order the employer to allow them to return them to their old job.

 

7.     The claims process:

How does the claims process work?

  • If you have the consent of the worker you can start the claim process on their behalf by submitting a claim form.
  • If a worker makes a claim, they should let you know as soon as possible and should provide you with their work capacity certificate.
  • Once the claim has been submitted, WCQ will first decide if the claim is to be accepted or not.
    • WCQ may contact you during this stage to gather further information in order to make their decision.
    • WCQ may take up to 20 business days to make a decision.
  • If the claim is accepted, WCQ may provide payments and support to the worker (dependant on their circumstances).
    • If being compensated for lost wages, the employer will usually pay the first week of compensation, and WCQ will manage payments from that point on.
    • WCQ will also assist the worker with other costs such as rehabilitation, medical expenses, and returning to the workplace.
  • If the claim is not accepted, WCQ will advise in writing.

 

8.     Types of claims:

A worker can make a statutory claim, and then proceed to a common law claim, or they can go straight to a common law claim.

What is a Statutory claim?

  • A statutory claim is where a worker makes a claim for statutory benefits, such as weekly compensation, and medical / rehabilitation costs.
  • This compensation is geared towards getting the worker back to the workplace.
  • A statutory claim is a 'no fault' claim, meaning workers are eligible to make a statutory claim regardless of who is at fault.
  • Under an Accident Insurance Policy, the following is covered for your workers: lost wages, medical / hospital / rehabilitation costs, travel expenses, lump sum payments, death benefits and funeral expenses.

What is a Common law claim?

  • A common law claim is where a worker sues their employer, if they feel the employer contributed to the work-related injury or illness through negligence.  
  • As part of the common law claim process, the worker must undergo a formal medical assessment, and employer negligence must be established.
  • Under an Accident Insurance Policy, the following is covered for your workers: past and future loss of income, medical / hospital / rehabilitation costs, legal costs, pain and suffering.

 

9.     Reviews:

Who can lodge an application for review?

  • An employer, worker, or claimant can lodge an application for review.
  • In Queensland, the Workers' Compensation Regulator are part of the Office of Industrial Relations ("OIR"), and are tasked with regulating Queensland's workers' compensation scheme. This includes the responsibility to undertake reviews of insurer (e.g. WorkCover Queensland) decisions.
  • If an employer is not satisfied with a decision made by WCQ, they may request a reasons for decision document from WCQ. This request must be submitted within 20 business days of the original decision.
    • A worker also has the right to submit this request to WCQ if they are unhappy with the decision.
  • Within three months of receipt of the reasons for decision document, the employer (or worker) then has the opportunity to submit an application for review with the OIR.
  • Not all decisions are eligible to be reviewed, however the following are examples of decisions which could be the subject of a review:
    • Acceptance or rejection an application for compensation.
    • Termination or suspension of payment of compensation.
    • Increasing or decreasing weekly payment of compensation.
    • WCQ failing to make a decision on an application for compensation.
    • A decision regarding the time to apply for compensation.
  • The review process is not a court process.
  • The review process involves a review of all the available and existing documentation which relates to a worker's application for compensation.

How does the review process work?

 

10.  Appeals:

Who can lodge an appeal?

  • An employer, worker, or claimant can lodge an appeal.
  • If an employer (or a worker) is not satisfied with the outcome of a review decision made by the OIR, they then have the option to lodge an appeal with the Queensland Industrial Relations Commission ("QIRC").
  • The appeal must be lodged within 20 business days of receipt of the review decision.
  • An appeal can be resolved by:
    • a decision from the QIRC after a hearing;
    • the party who has filed the appeal (either the employer or the worker) discontinuing the appeal; or
    • the OIR seeking orders to concede the appeal.

How does the appeals process work?

 

11.  Legal representation (common law claims only):

Do you need to find legal representation?

  • WCQ will appoint a law firm from their approved legal panel to represent and act on behalf of an employer when a common law claim is lodged by one of their workers.

What role do the lawyers play in the process?

  • Following being appointed by WCQ, a lawyer from the law firm will contact the employer to confirm they are acting on their behalf and to discuss the process.
  • The lawyer's aim is to work with the employer to try to prove that they have taken reasonable steps to ensure they have adequate WHS policies and procedures in place, and that they have not been negligent.
  • Ultimately, the lawyer will help the employer to defend the claim.
  • The appointed law firm will represent the employer through the negotiation and trial process which they will engage in with the Claimant's (the injured worker) lawyers.

For further information on this process please visit: https://www.worksafe.qld.gov.au/claims-and-insurance/compensation-claims/common-law-claims/negotiating-an-outcome

 

12.  Paying excess on your insurance premium:

What do you need to pay excess?

  • You will need to pay excess if:
    • Your worker has taken time off work as a result of a work-related injury or illness; and
    • Your worker's claim is accepted.
  • Your excess will be paid to the injured worker as their first weekly payment of compensation.

For further information, visit: https://www.worksafe.qld.gov.au/claims-and-insurance/workcover-insurance/types-of-insurance/accident-insurance

 

13.  The return to work process:

It is important to support and encourage your worker in returning to the workplace (if it is safe for them to do so) as this is a significant step in their recovery.

How does the return to work process work?

  • WCQ will work with you as well as medical or rehabilitation specialists to develop a rehabilitation and return to work plan for your worker.
  • You should aim to offer flexible working arrangements / duties to help your worker come back to work if needed (WCQ can also provide other options if this is not possible). This may include:
    • Working from home arrangements.
    • Suitable duties.
    • A staged return to work (e.g. three hours per day on Mondays, Wednesdays, and Fridays – then increasing hours and days as they recover to pre-injury capability).
  • Ensure your RRTWC manages and monitors your worker's return to work process. If you do not have a RRTWC ensure a suitably competent and qualified staff member is managing this process.

For further information, visit: https://www.worksafe.qld.gov.au/rehabilitation-and-return-to-work

 

14.  Steps to prevent a reoccurrence:

After a work-related injury or illness occurs in your workplace, it is important to review the situation and your workplace to try to prevent a similar incident occurring in the future.

What steps should you take to prevent a reoccurrence?

  • Investigate the incident to understand how and why the worker was injured. Once you know why, you can take steps to avoid more injuries.
  • Review your WHS documentation, policies, procedures, and instructions to ensure they are up to date and being followed.
  • Conduct an updated risk assessment of your workplace, or the specific task or duty related to the incident.
  • Conduct a WHS audit or inspection of your workplace to see if your safe working procedures are being followed, and workers are wearing their PPE correctly.
  • Review other safety controls and preventative measures that are in place to ensure they are effective and being used / working correctly.
  • Speak to and consult with your workers and get their feedback.

 

Contact numbers and websites

WorkCover Queensland - 1300 362 128. ht

Workers' Compensation Regulatory Services – Reviews and Appeals unit, phone 1300 739 021

Workplace Health and Safety Queensland – reporting incidents (ask for inspector), 1300 362 128. 

Office of Industrial Relations – 1300 362 128

 

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. 

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. 

The Workers' Compensation Regulatory Services 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 Office of Industrial Relations which also oversees work health and safety and electrical safety in Queensland. 

 

What are high risk industries?

Industries are categorised in this schedule using a system known as the Australian and New Zealand Industrial Classification (ANZSIC).  

For more information visit: https://www.worksafe.qld.gov.au/laws-and-compliance/workers-compensation-laws/guidance-materials/high-risk-industries