Compensation and lodging a claim FAQs - Workers
Compensation and lodging a claim FAQs - Employers
Compensation and lodging a claim FAQs - Workers
I'm a casual worker - am I still covered for workers compensation?
Regardless of a worker's status (ie, full-time, part-time or casual), if they are deemed to be workers under the Act they are eligible for compensation if they are injured or made ill as a direct result of their work.
What happens if I am hurt at work but my employer isn't registered with WorkCover?
Workers are covered regardless of the employer's status with WorkCover.
If I am hurt on the way to work, is this covered?
These are known as 'journey claims' and are not usually covered by workers compensation in South Australia. If you leave home and travel straight to work and have an accident, generally you are not covered. However, all cases are individually analysed by the case manager.
If I am hurt at work, but I was drunk, is this covered?
Generally, if you were drunk at work and it is reasonable to believe that the injury is attributable to your intoxication, your claim will be rejected. This includes all drugs other than those that are legally prescribed.
What should I do if I am hurt at work and my employer tells me not to make a claim?
All workers have the right to make a claim for compensation if they have been hurt at work. An employer cannot direct a worker not to claim for compensation as a result of being hurt at work. Workers compensation cover protects both worker and employers from the often severe financial impact of workplace injuries. Cover also provides both workers and employers with access to professional health care resources and claims management.
Do I need to report an injury if I don't intend to claim?
You should report an injury even if you don't intend to make a claim because with the passage of time the injury could get worse. Reporting an injury also enables your employer to track (and fix) potentially dangerous tasks or equipment in the workplace. For more information view injury reporting.
Are there any time limits on when I can lodge a claim?
There are time limits (normally six months from the date you first need time off or incur expenses as a result of an injury.) If you lodge a claim outside that timeframe, and the claims manager rejects it based on it being lodged late, you may have to appeal to the Workers Compensation Tribunal if you feel you have a valid reason for the late lodgement.
What do I do after I get my PMC?
As soon as possible after suffering an injury at work, the worker should obtain the PMC from the doctor and lodge it together with a completed claim form with the employer. The sooner all this is done, the quicker the process can commence. You can also ring WorkCover on 13 18 55 and complete the process over the phone.
Can my employer refuse to lodge a claim?
Legally, they can't. If your employer does refuse, you can still lodge a claim independently through WorkCover.
What records of claims are kept on employee records?
Employers must keep reasonable records of workers compensation matters but those records must be kept confidential, unless you give your permission to disclose personal information.
Can I choose my own doctor if I have time off work or make a claim?
Yes, you can choose your own doctor and/or treating specialist. The only time WorkCover can specify which doctor you see is if we arrange an independent medical examination.
Are claims investigated?
Not all claims are investigated but WorkCover and/or case managers will make a decision on compliance-related issues on a case-by-case basis. Fraud costs the community through higher workers compensation levies, lower profits for employers, lower wages for workers, lost jobs and higher prices for goods. We take fraud seriously and thoroughly investigate allegations received. For more informationview fraud.
Who decides if a claim is accepted?
The case manager, acting under the claims management agreement with WorkCover. For more information view acceptance of a claim.
Can I be sacked for making a claim?
Legally, you can't, but if this happens you should contact your case manager and/or seek independent legal advice.
Do I have to tell a new employer about a claim in a previous job?
If an employer asks whether you have previously made a claim for workers compensation, you have a responsibility to be truthful in your answer, however, there is no obligation under the Act for you to disclose a previous claim.
What if I was injured in a previous job but never claimed - can I still get my physiotherapy paid?
Under the Act, a worker is entitled to be compensated for costs reasonably incurred as a result of having suffered a compensable disability. This means you must lodge a claim, and the Act says you must lodge it within six months of incurring the expense. However, if a longer period has gone by since you injured yourself, you can still lodge a claim, but the claims agent will have to be satisfied there was a reasonable excuse for not lodging it earlier, and that they can still reasonably determine what happened.
I work for a self-insured employer, do I use the same forms to make a claim?
Yes, all claims are documented on the same forms regardless of who manages the claim and the associated costs.
How does a claim differ from ordinary sick leave?
Taking sick leave for a work injury may leave you liable for expenses that should be covered by compensation. The injury may develop to become more complex or costly. WorkCover provides claimants with access to professional health care resources and claims management. Apart from income maintenance payments, there are also a number of other payments that may be made over the life of a claim, including payment for health care services, medicines, travel to and from medical treatment or rehabilitation or a permanent disability. For more information view entitlements.
Is my employer allowed to contact my doctor?
Only with your permission, and you should only give permission for matters relating strictly to your claim to be discussed. You are not obliged to give such permission to your employer. Your doctor is bound by the Privacy Act (an Act of the Commonwealth Parliament) and can only disclose certain information. For more information view workers rights and responsibilities.
Compensation and lodging a claim FAQs - Employers
Do you cover part-time/casual workers?
Regardless of a worker's status (ie, full-time, part-time or casual), if they are deemed to be workers they are eligible to claim compensation if they are hurt or made ill as a direct result of their work.
What happens if workers are injured outside of South Australia?
Each state and territory has its own workers compensation laws. If you are registered with WorkCover in South Australia and one of your workers is injured whilst working out of South Australia, they should lodge a claim with WorkCover SA. We will advise you if the claim will be met here or if the worker should lodge another claim with another state's jurisdiction.
Do you cover workers who are over 65?
Generally, workers compensation payments cease at the time a worker would normally retire. For most people this would be age 65 but in some circumstances it may be different. Medical expenses may continue beyond 65.
Am I covered as a self-employed person?
No, you will need to take out your own sickness and accident/income maintenance insurance.
Do you cover apprentices?
Yes, an apprentice is a worker and so is eligible to claim compensation if hurt at work.
Do you cover contractors?
Generally, where a worker is employed under a contract of service instead of a contract for service, they are considered to be workers for the purposes of workes compensation and are therefore eligible to claim if hurt at work. This is a complex issue and you should seek advice from your claims agent.
Do you cover work experience kids?
People doing work experience are generally not classed as workers and therefore are not eligible to claim compensation.
Do new workers have to disclose pre-existing injuries to us before we hire them?
There is no requirement in the Workers Compensation and Rehabilitation Act 1986 for workers to disclose this information, however as an employer you have the right to ask the question.
I have a part-time business plus full-time employment. Occasionally I hire staff on a contract basis. What responsibilities do I have for WorkCover for those contractors and when do I require self-insurance?
The answer to this question depends on the basis of employment for your contract staff. If they are working under a contract of service, you would need to pay a WorkCover levy for them. If they are working under contract for service, generally, you would not be responsible for them. However, this issue is complex and you should seek direct advice from the agent.
Do I need WorkCover for businesses that do not operate within SA but which might have employees going there from time to time?
Generally, we would expect these businesses to have workers compensation cover in their state of origin. However, in some circumstances it may be necessary to cover them in South Australia by paying a levy to WorkCover SA. This issue is complex and you should seek direct advice from the claims agent.
What records do I have to keep about injury reporting?
The worker needs to give you a Notice of Disability where an injury occurs and if necessary, a claim for compensation. If a claim for compensation is lodged, you must also complete an Employer Report Form and send that and the claim to your claims agent. You should keep copies of all such notices and also copies of any correspondence relating to the matter.
What happens if I lodge the paperwork late?
You may be fined up to $1,000 and/or have a supplementary levy applied.
Who decides if a claim is accepted?
The case manager, acting under the claims management agreement with WorkCover.
How long does it take to determine a claim?
The claims agent generally must make a decision about whether the claim is accepted or rejected within 10 business days from receipt of the claim (unless further information is needed). In some cases the claims agent may defer the decision and may pay the worker interim income maintenance in the meantime. If the claim is eventually rejected, the worker will have to pay back this money.
What happens if there is a delay in determining a claim?
If a claim has not been determined within a reasonable period, (which will depend on the circumstances), the worker or employer can apply to the Workers Compensation Tribunal for an expedited decision. The agent may pay interim income maintenance in the meantime.
Are claims investigated?
Not all claims are investigated but WorkCover and/or case managers will make a decision on compliance-related issues on a per case basis. Fraud costs the community through higher workers compensation levies, lower profits for employers, lower wages for workers, lost jobs and higher prices for goods. To make an allegation view the fraud section.
What happens if a claim is false?
If WorkCover is satisfied that a claim is dishonest, the person who committed the offence may be prosecuted.
Does the agent have to accept the claim?
All claims must be determined and the claims agent will advise all parties of the result, whether it is to accept or reject a claim.
Do work-related claims have to be witnessed by anyone?
The Act does not require a witness although the question is asked on the claims form.