Claiming Compensation For Work InjuriesArticle kindly supplied by Hall Payne Solicitors Please note: this advice is for residents of Queensland only - legislation differs from state to state. If you have hurt yourself while at work (or performing some work-related duty away from work), and you require time off work because of the injury or need medical treatment/rehabilitation then chances are you can claim workers compensation benefits. To be able to claim for compensation you must be a "worker" and have suffered an "injury". Who is a worker?Until 1 July 2000 a worker is an individual who performs work under a contract of service and is a Pay As You Earn (PAYE) taxpayer. After 1 July 2000, a worker will be an individual who works under a contract of service regardless of their tax paying status. If you are a PPS taxpayer, until 1 July 2000 you are not a worker within the meaning of the Act and therefore not entitled to compensation. PPS workers may be able to claim an ex gratia lump sum payment for injuries sustained between 1 July 1999 and 30 June 2000. What is an Injury?Prior to 1 February 1997 your employment had to be a significant contributing factor causing the injury before you were entitled to compensation. Between 1 February 1997 and 30 June 1999 your employment had to be the major significant factor causing your injury for you to be entitled to compensation. From 1 July 1999 if you are injured you will be compensated if your employment is a significant contributing factor causing an injury. Also, if you aggravate a pre-existing injury or condition during your employment you will be entitled to compensation but only to the extent of the aggravation. Some examples of compensable injuries include: a cut or fracture significant pain as a result of constant use of a part of your body (eg lower back pain, pain in your arms/shoulders/ wrists) a disease (eg Q fever, asbestosis related disease) industrial deafness Psychological injury (depression, mood disorder)
How To ApplyIf you have been injured at work, you should take the following steps to apply for compensation: Report the injury to your employer as soon as practical. If you require medical attention or are unable to continue working, visit a doctor of your choice for an examination as soon as practicable. If the doctor agrees your injury is work-related, they should give you a WorkCover Medical Certificate. The original copy of the medical certificate goes to WorkCover and a copy to your employer. Fill in a Compensation Claim Form for Workers and Employers . This form is available from your employer, your union, or your nearest WorkCover office. This form can also be completed over the phone by calling 1300 362 128. Obtain and complete an Employment Declaration if you are claiming for wages lost due to time off work. Attach your WorkCover Medical Certificate to the Compensation Claim Form and attach an Employment Declaration (if required). These forms are needed for WorkCover to consider your application.
If you are unsure about what to do contact your Union delegate/official or your lawyer. Entitlement to compensation for an injury arises on the day you are examined by a doctor. You must lodge your application within 6 months from the date your entitlement arises. If an application is lodged more than 28 days after the entitlement arises, WorkCover will only reimburse any medical expenses incurred or wages lost for the 28 days before you lodge your application. It should be remembered that WorkCover can still decide a late application, if certain special circumstances exist.
Deciding your applicationTo reach a decision to accept or reject a claim WorkCover may talk with you, your fellow employees, your Doctor and your employer. WorkCover must reach a decision to accept or reject your claim within 3 months of you making an application. If WorkCover are going to reject your claim they must provide you with written reasons of that decision. Sometimes the decision to accept or reject a claim will be too difficult for the Claims Officer to decide and you may be referred to a Medical Assessment Tribunal (MAT). If you are referred to a MAT you should speak with your Union as representation may be needed to maximise your chances of having the claim accepted. A decision to reject your claim made by a MAT can only be reconsidered in special circumstances. However a decision to reject your claim, made by a claims officer is always reviewable. Reviewing/appealing a claim decisionA worker who is not happy with a decision about a claim can apply for the decision to be reviewed by WorkCover. The application for Review must be lodged within 3 months from the date you receive the decision to reject you Application. The review is conducted by the Review Unit of Q-Comp. If a worker chooses to use a solicitor or another person to help prepare the application, WorkCover will not pay these costs. But if you are required to obtain medical evidence to support your Review Application, and you are successful at Review, WorkCover will reimburse to you any outlays incurred in obtaining this medical evidence. The Review Unit have 35 days to review the decision and a further 14 days to notify the applicant of the decision. An employer or a worker who is not happy with Q-Comp's review decision can appeal to the Industrial Magistrate. Appeals to Industrial MagistrateAn appeal to the Industrial Magistrate must be made within 28 days of receipt of the Review decision. The registrar of the court will advise the time and place fixed for the hearing. Normally you will be required to give evidence at this hearing. However, if a member is considering appealing a decision by Q-Comp Review Unit to the Industrial Magistrates Court, then the member should give serious consideration to retaining legal representation. The Union will of course assist the member in relation to recommending a solicitor experienced in this area. Self-insurersIf your employer is self-insure red, you have the same workers' compensation rights as other workers. The only difference is that you must make your application for compensation to your employer rather than to WorkCover. If you are employed by a self-insurer and believe a wrong decision has been made by your employer about your application, you can ask WorkCover to review the decision. The review process (refer above) will be the same as for all other workers. Your employer should notify you if they become a self-insurer. Workers' ResponsibilitiesIf you have applied for compensation, you must provide information that is accurate and true to the best of your knowledge to WorkCover at all times. If you do not, WorkCover can charge you with fraud or attempted fraud If you return to work and do not advise WorkCover, they can also charge you with fraud. Rehabilitation and WorkCoverWorkCover states that one of its aims is to help injured workers to return to and remain in suitable employment as soon as possible following an injury. It believes the workplace is the most appropriate and effective place to rehabilitate most workers. A good rehabilitation programme may involve treatment, a suitable duties programme, on-the-job training to acquire a new job skill or special assistance for severely injured workers. WorkCover provide qualified rehabilitation counsellors for you who provide advice and assistance. The Act requires injured workers to participate in rehabilitation programmes as soon as possible after injury. A failure or refusal to participate may result in compensation payments being suspended, or in the serious cases, cancelled altogether. You will not be obliged to participate in a rehabilitation programme until your Doctor has approved the proposed plan. Your Doctor will be required to confirm with the Rehabilitation Co-ordinator that they are satisfied with the plan. This is done to ensure that the programme is appropriate given the injury and the Doctor's course of treatment. WorkCover will only pay : expenses for accepted current claims, and for services WorkCover has given prior written approval for payment.
Self insured employers will have different arrangements in place for rehabilitation programmes. If you have any problems with the programme you should talk to your Rehabilitation Co-ordinator, your union delegate/official (who may indeed consider it necessary for you to consult with the union lawyers). Finalising your ClaimOnce you have returned to work or if the injuries have become stable and stationary, you can ask WorkCover to assess you for a permanent impairment assessment. A Notice of Assessment should then be issued. This Notice Of Assessment will detail the Permanent Impairment assessment and your work related impairment (WRI) and will contain an Offer of Lump Sum Compensation. It will ask you firstly, whether or not you agree or disagree with their assessment of your permanent impairment. If you disagree with the assessment, you can elect to have the claim referred to the Medical Assessment Tribunal for final determination. If you agree with the assessment you will then need to decide whether or not to accept, reject or defer the offer of lump sum compensation. Whether you should reject or accept an offer will most probably be one of the more important decisions you will have to make in your life. You really should speak to your union about what you should do when you get a Notice of Assessment. Do not tick any box on the Notice until you have spoken with someone from your Union, as you may, without knowing it, tick away your right to recover damages from a Court. Damages at Common LawIf the injury was someone else's fault (e.g. your employer or your co-worker) you may be able to claim compensation at Common law. It is therefore very important that before a decision is made to accept or reject any offer of lump sum compensation that you speak with your union delegate/official and your lawyer. There is a strict 3-year time limit from the date of injury that applies when making a Common Law claim (although in some very special circumstances this time limit may be able to be extended). Several steps must be taken before making this type of claim. It is important that any person injured at work or during the course of their employment act promptly to protect their rights to compensation. The first step will nearly always involve lodging an Application for Compensation with WorkCover (or if applicable, the self insurer).
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