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Home > News > Blog Post: Understanding WorkCover.

Blog Post: Understanding WorkCover.

2019-11-30

The following article was authored by a source who wishes to remain anonymous. The article is a reflection on this person’s journey as an injured worker, accessing the WorkCover system.

Please note: while this article contains some suggestions on accessing WorkCover, as everyone’s situation is different, we recommend your speak to your union or a legal representative regarding your own personal situation.

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On Christmas eve 2016, I was injured at work. 3 years later I am still recovering. Here is what I learned along the way.


Get help!  The number one most important part of a WorkCover claim is your own health. If you are sick or injured, see your doctor. If your injuries are severe, call an ambulance! Don’t worry if you don’t have cover, that’s what WorkCover insurance is there for. It’s a “no fault” insurance scheme that covers every worker. The first thing someone providing treatment should ask you is, “Did this happen at home or at work?” - that’s so they know who should pay the bills. 

Always see your own doctors.  Not too much to say here other than you have the right to select your own treating professionals. If the boss tells you to see one of their doctors, consider calling the union prior, or simply visit your existing doctor.

What’s covered?  WorkCover will pay ‘medical and like expenses’ which could include doctor’s fees, medications, X-Rays, MRI, surgery, physiotherapy, as well as things like crutches, travel and household help. If you need time off work for treatment or recovery you may also receive weekly payments. Basic stuff is automatically covered such as a GP appointment, but more specialist treatment may require a ‘letter of authorisation’ from the WorkCover Agent (Insurer). It’s important to note that  reasonable cost  is set by the authority so check with the treater so you won’t end up out of pocket. Also, travel expenses for treatment are covered so don’t forget to claim these so you don’t end up out of pocket.

Oh, the paperwork!  The reality is the Workers Comp Claim form and Certificates of Capacity will be essential to your claim. I won’t go into too much detail here other than to say talk to your union BEFORE submitting the form to the employer. The  Victorian WorkCover Authority  has a step by step guide for injured workers making a claim.  Slater and Gordon  also have a great guide to help with your claim. Keep a copy of absolutely everything, it will pile up but it may be very important later on.

Invoicing the agent.  So, you’re getting treated, that’s great! Some treaters will require upfront payment, whereas some will invoice the agent directly. For instance, medications dispensed outside of a hospital will likely incur you an upfront cost. You MUST submit invoices to the agent within 6 months for reimbursement.

Weekly payments: what I wish I knew.  If your claim requires you to have time off work for treatment or recovery, you will probably be getting  weekly payments . For the first 13 weeks you’ll receive 95% of your pre-injury average weekly earnings (PIAWE). After this it will drop to 80%.

It’s really important to understand what a week is to WorkCover. If you needed to take a day off to see a doctor, that counts as 1 week of your payments. In my case where I had surgery after 10 months, I had already well and truly exhausted my 13 weeks and spent 15 weeks unable to work on only 80% of my wage. You are also entitled to use other types of leave on WorkCover such as sick leave or annual leave until exhausted. It’s also important to remember that superannuation is not paid on weekly payments for the first aggregate 52 weeks.

You can’t be sacked for being injured… well almost.  It’s illegal to be sacked simply for being injured. Your employer and agent have a  52 week obligation  to you. If you are unable to return to full pre-injury duties during that period, the protection no longer exists. If you have returned to work in some capacity, such as modified duties, it is unlikely you will be sacked. Again, if you have any concerns regarding this, please contact your union as soon as possible.

Your union rep should be your best friend.  Support is  really important  throughout the journey. Having a professional who knows what they are doing is essential for any injured worker. I could not tell you the number of times I called my union to speak to a WorkCover specialist during my time.

If your agent or management schedule a meeting, take your rep with you! I cannot stress to you enough the importance of this. You can also call the  WorkCover  advisory service; they pick up the phone really quickly.

Find your supporters.  Lastly and probably most importantly are your supporters. They are as important to your recovery as any treatment is. They’re the ones who will pick you up when the doctors won’t let you drive home. They will care for you both physically and emotionally. They’re the ones who will tell you not to give up. My Dad gave me some really solid advice; don’t let this injury define you.

Finally, it's important to note that if an injury, whether physical or psychological is very serious, further compensation may be available. This may be through a statutory claim through the VWA or through Common Law legal action. This is why it’s so important to speak to the great team at Slater and Gordon who can provide you with advice and support.