Workcover Processes

Under normal circumstances, an employer is responsible for the first 10 days of weekly benefits for an injured worker who is off work, and the first (annually indexed) dollar amount of reasonable medical and related expenses. However, employers can avoid this cost by taking up a buy-out option with an insurer and paying an additional loading on their premium. This means that any claims are managed and paid for by the insurer from day one, making it easier for employers – especially small employers, such as kindergartens and other early childhood services – to manage the early stages of a claim.

While many services will not have had a WorkCover claim in the past, the potential cost of a future claim could seriously affect a service operating on a limited budget.

TIP Both KPV and Allianz recommend that all services consider taking the buy-out option. This would need to be taken prior to the commencement of the policy period each year.

If an employee needs medical treatment or time off work as a result of a workplace injury, she/he must notify the employer within thirty days. If an employee provides the employer with a notice of injury, the employer must acknowledge the notice of injury from the employee in writing. Employers must display the current ‘If you are injured’ poster within their workplace. They can obtain one from their VWA Agent or can be downloaded from the WorkSafe website. Www.worksafe.vic.gov.au.

Employees may be entitled to workers’ compensation if they suffer a work related injury or illness. For an injury or illness to be considered work related, it must have been significantly contributed to by employment.

Compensation is generally not payable for stress that arises from reasonable actions by the employer relating to transfer, demotion, discipline, redeployment, retrenchment, dismissal, promotion, granting of leave or work benefits.

Furthermore, injuries sustained while travelling to or from work are not regarded as work related (but may be covered under Transport Accident Commission (TAC) laws). However, injuries suffered while travelling in the course of employment are covered.

Step 1
To make a claim, an employee must complete a WorkCover worker’s claim form (available from any post office) and give it to his/her employer. If the claim is for time off work, the form must be accompanied by a WorkCover medical certificate.

Step 2
On receipt of the WorkCover worker’s claim form, the employer must complete the employer section of this form and acknowledge receipt of the claim in writing as soon as reasonably practicable. The employer must also complete a WorkCover employer’s claim report, deciding whether or not liability should be accepted. It is important for the employer to consult with their VWA agent before any decision is made. Where a claim is accepted, most employers are required to pay an excess – first 10 days of compensation and the first (annually indexed) dollar amount of reasonable medical and related expenses, except where employers have taken up the buy-out option, which was explained above. The employer must forward the claim form (and any other relevant documentation) to their VWA agent within 10 days if:

• medical expenses are likely to exceed the specified dollar amount
• any time off work is required
• there is doubt as to liability.

The VWA may impose a penalty on an employer’s premium if claims are not received within 10 days. Employers who have taken the buy-out option should send the completed WorkCover worker’s claim form, WorkCover employer’s claim report and all medical invoices to their VWA agent, who will cover all costs. Copies of all documents should be retained by the employer.

Step 3
The VWA agent will accept or reject the claim within 28 days of receiving it.

First medical certificate

An employee’s claim for compensation must be accompanied by a medical certificate from a legally qualified medical practitioner (not a physiotherapist, chiropractor or osteopath) and must contain all relevant information required to make an assessment of capacity to work. The initial medical certificate can only be issued for 14 days or less off work, unless there are special reasons – for example, where the worker has a severe injury or disease – which must be stated in the comments section of the certificate.

Ongoing medical certificates

Ongoing certificates can certify an employee as being incapacitated for up to 28 days. These can be issued by a medical practitioner, physiotherapist, chiropractor or osteopath.

If an employee suffers a work related injury or illness and needs time off work, she/he may be entitled to weekly benefits from WorkCover. The amount of weekly benefits that the employee receives will depend on:

• their current work capacity
• their pre-injury average weekly earnings (PIAWE), which may include overtime and shift allowances
• the length of time the employee is on benefits.

The employer’s VWA agent will work out the amount that the employer needs to pay. In the meantime, the employer can assist the worker by paying any accumulated sick leave and, if the worker requests and it is appropriate, any available annual leave. If the agent later accepts the claim, the employer should recredit these leave entitlements to the worker. In addition to weekly benefits, an employee may also be entitled to a separate benefit if a work related injury or illness leaves them with a permanent impairment. If an employee submits this kind of claim to his/her employer, the employer must send it to the VWA agent within 10 days.

TIP KPV strongly recommends employers contact both their VWA agent and KPV for advice if any employees lodge a WorkCover claim.

The earlier a worker can return to work following injury, the better it is for the worker and for an employer’s business. Understanding his/her legal obligations and knowing what to do can reduce the impact on the employer and employees.

In July 2010, new return to work requirements came into effect. From April 2011, all employers must fully comply with the revised return to work obligations. WorkSafe Victoria have produced a number of useful publications on return to work including:

• Return to Work Co-ordination – the basics you need to know,
• Returning to Work – A guide for injured workers,
• Return to Work Arrangements – Template and Suitable employment for injured workers – A step by step guide to assessing suitable employment options.