Behind the Scenes: Understanding the Evaluation Process for WorkCover Claims in Queensland

Behind the Scenes: Understanding the Evaluation Process for WorkCover Claims in Queensland

Published on 31 May 2023
Last updated on 29 February 2024

When you get injured on the job, you are entitled to make a claim for workers’ compensation benefits. The process of making a claim and having it accepted can be a complex and lengthy one, with a number of criteria needing to be assessed before a decision is made. In this article, we will take a look at how WorkCover determines the validity of a claim and how long the process typically takes.


Behind the Scenes: Understanding the Evaluation Process for WorkCover Claims in Queensland


1. The Criteria for a Valid Claim

When a claim is made for workers’ compensation benefits, WorkCover will assess a number of criteria to determine whether the claim is valid. These criteria are laid out in the Workers Compensation and Rehabilitation Act 2003 and include the following:


1.1 Timeframe

The claim must be made within the appropriate timeframe, which is generally within 6 months of the injury occurring. If the claim is not made within this timeframe, it may still be accepted if there is a reasonable excuse for the delay.


1.2 Employment

The person making the claim must have been employed by the relevant employer at the time of the injury. This includes casual and part-time employees, unpaid interns, as well as contractors in some cases.


1.3 Work-Related Injury

The injury must have been caused by a work-related incident. This can include physical injuries, such as sprains, strains, or fractures, as well as illnesses or diseases that are caused or aggravated by work activities.


1.4 Additional Criteria That May Be Applied in Certain Circumstances

In some cases, additional criteria may be applied when assessing a claim for workers’ compensation benefits. For example, claims involving psychological or psychiatric injuries, industrial deafness, or latent onset illnesses may require more information to be assessed. This may include evidence from medical specialists, additional documentation from the employer, or expert reports.


2. How does WorkCover Make a Decision on a Claim?

Once a claim has been lodged, WorkCover will assess the claim to determine whether it meets the criteria for a valid claim. Here is an overview of the process that WorkCover uses to make a decision on a claim:


2.1 The Role of WorkCover in Assessing Claims

WorkCover is responsible for administering the workers’ compensation scheme and assessing claims for benefits. WorkCover employs claims officers who are responsible for gathering information and evidence, making decisions on claims, and managing any disputes that arise.


2.2 The Process of Gathering Information and Evidence

When a claim is lodged, a claims officer will be assigned to the case. The claims officer will contact the worker, the employer, and any medical practitioners involved in the worker’s treatment to gather information and evidence. This may include medical reports, witness statements, and other documentation.


3. How Long does the Decision-Making Process Take?

WorkCover aims to make a decision on a claim within 20 business days. However, in some cases, additional information may be required, which can cause delays in the process. In such cases, the claimant will be notified and given reasons for any delay.

If the claimant is not satisfied with the decision made by WorkCover, they have the right to request a review by the Workers Compensation Regulator. The regulator will review the decision and may overturn it if they find that WorkCover has made an error or has not followed the correct process.


4. Conclusion

In conclusion, understanding how WorkCover makes a decision on a claim is essential for anyone who has been injured in the workplace. The criteria for a valid claim, the process of assessing a claim, and the factors that WorkCover takes into account when making a decision are all important considerations.

If you have been injured at work and are considering making a claim, Ascent Lawyers recommends seeking professional advice to ensure that your claim is valid and that you receive the compensation you are entitled to.

Disclaimer: Ascent Lawyers owns all copyright in the text. This article is of a general nature and should not be regarded as legal advice or relied on for assistance in any particular circumstance or emergency situation. To obtain legal advice in relation to your own circumstances, please contact us for consultation.

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