Who Is Entitled to WorkCover in Victoria?

When You Can File a WorkCover Claim

WorkCover is the state workers’ compensation program in Victoria. It is compulsory for all employers in VIC to have WorkSafe insurance if they:

  1. Expect to pay more than $7,500 in wages and benefits during the coming financial year
    AND/OR
  2. Employ trainees and/or apprentices

With this in mind, the vast majority of employees in VIC may have access to WorkCover benefits through their employer’s insurance if they are hurt or get sick on the job. Unfortunately, injured workers often face a number of obstacles to receiving the benefits they deserve.

Keep reading for information on when you may be entitled to benefits for a workplace injury or work-related illness. If you need assistance with a WorkCover claim, contact Henry Carus + Associates for a free, no-obligation consultation.

Were You Injured at Work?

The most common scenario in which workers may be entitled to benefits is an on-the-job accident resulting in injury. WorkCover benefits for medical treatment expenses and wage replacement may be available for injuries such as:

  • Sprains and strains
  • Cuts and lacerations
  • Broken bones
  • Soft tissue injuries affecting the muscles, tendons, ligaments, etc.
  • Head and brain injuries
  • Neck injuries
  • Back injuries
  • Injuries to the hands, arms, legs, and feet

In addition to acute injuries (i.e., injuries that occur due to a traumatic incident), workers may be entitled to WorkCover benefits for chronic injuries that result over time. According to the Australian Bureau of Statistics, chronic joint and muscle conditions are the second most common type of work-related injury (behind sprains and strains).

These chronic conditions are often the result of overexertion and repetitive motions on the job. If this is the case, you may be entitled to benefits through a WorkCover claim.

Did You Become Ill Because of Your Work?

WorkCover benefits may also be available to workers who get sick on the job. According to Safe Work Australia, mental health conditions account for the highest percentage of work-related diseases. Typically this refers to mental stress, although you may have a claim for benefits if you suffer another form of psychological injury on the job.

Benefits may also be available for physical illnesses related to work. Diseases that may result in lost work time include:

  • Conditions of the nervous system (brain and nerves)
  • Diseases affecting the sense organs (i.e., the eyes, ears, etc.)
  • Diseases of the cardiovascular system (affecting the heart, arteries, veins, and capillaries)
  • Digestive system diseases (affecting the esophagus, the stomach, and the intestines)
  • Diseases of the lungs and respiratory system
  • Conditions of the skin and subcutaneous tissue
  • Infectious diseases
  • Parasites
  • Cancers

The risk of workplace illness varies by industry. Trades workers are exposed to many more toxic and hazardous substances than somebody working in an office building. Nonetheless, anybody can get sick because of their work.

How Do I Get the WorkCover Benefits I Deserve?

The very first thing you should do after any workplace injury or illness is to seek medical treatment. You do not have to wait till after your claim is started to seek care, and you may be entitled to reimbursement of previous medical expenses.

To receive benefits, you will need to file a WorkCover claim which is first submitted to your employer. Your employer, as part of the WorkCover system, then submits the claim form and its own Employer Claim Form to its VWA-Authorised Insurer.

If you are claiming weekly payments for time lost from work, you will first need a Certificate of Capacity that describes your injury or illness and assesses its impact on your ability to work. If you are only claiming medical expenses, you do not need a Certificate of Capacity.

Getting the initial Certificate of Capacity requires an attendance on a medical practitioner (i.e., a doctor, surgeon, or psychiatrist). Subsequent certificates (which are necessary if your claim for weekly payments goes beyond 28 days) may be issued by a physiotherapist, chiropractor, or osteopath, or again by a medical practitioner.

Why Do I Need a Lawyer for My WorkCover Claim?

Unfortunately, many workers struggle to get their WorkCover Claim accepted or end up receiving less than all WorkCover benefits they need and deserve. If your claim is denied or you believe your benefits are underpaid, it is important to contact a workers’ compensation lawyer as soon as possible.

A lawyer experienced in WorkCover claims can take a variety of actions on your behalf:

  • Evaluate from the start if you may be entitled to Common Law compensation later on, and act immediately to secure the evidence that may be needed later on to show who is responsible for your injuries
  • Advise you in respect of decisions made by the WorkCover Authorised Insurer and, if needed, ask that Insurer to reconsider a decision
  • Refer any decisions in dispute to the ACCS for conciliation of the dispute
  • If a dispute cannot be resolved, advise if a referral to the Medical Panel is appropriate or instead issue legal proceedings to access your benefits
  • Advise if you should seek a lump sum amount of compensation by way of an impairment benefit, and when that should be lodged
  • Explain Common Law rights and the process by which they can be sought in time
  • If Common Law rights are open to you, apply for a serious injury certificate (one or two as appropriate to your situation)
  • Once access to Common Law rights is gained, assist in the process, with or without litigation, to achieve the best possible compensation for you
  • Explore your options for additional benefits, such as any insurance benefits under a personal income protection policy or for Total and Permanent Disability under a Superannuation Fund

Common Law compensation that may be open to you includes compensation for pain and suffering and for loss income, past and future, that you have suffered due to the negligence of your employer or another party.

Get Help with Your WorkCover Claim

Being injured or getting sick at work is never easy. Having the benefits you need to pay your bills and protect your finances delayed or denied only makes matters worse. If you are facing this situation, it is important to seek qualified legal advice and assistance as soon as possible.

Henry Carus + Associates have unsurpassed knowledge and experience helping injured workers get the benefits and other compensation they deserve. Read our Success Stories to see what clients have to say about the service we provide and the results we achieve.

Please call 03 9001 1318 today for a free, no-obligation consultation. We handle WorkCover claims on behalf of clients in Melbourne and throughout Victoria.

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