Workers Compensation Claims Procedures
By keeping a current workers’ compensation insurance policy and having an injury management system in place, the employer will ensure compliance with the Workers’ Compensation and Injury Management Act 1981(the Act).
When can a Worker make a claim for workers' compensation?
Workers can make a claim for workers' compensation if they suffer any of the following, and any one of them results in time off work or requires medical treatment.
- a personal injury by accident arising out of, or in the course of employment, or while acting on the employer's instructions
- a disabling disease
- a disease contracted in the course of employment, or the recurrence or aggravation of a pre-existing disease
where the employment contributed to a significant degree
How does the worker make a claim?
- Immediately seek first aid and report the injury to your employer.
- As soon as possible, see the doctor of your choice and ask for a First Medical Certificate (Word – 250kb).
- Fill out a Workers’ Compensation Claim Form. If they have difficulty completing the form, first speak to the employer – if
they are still unsure, contact Advisory Services - Take a copy of the Certificate and Claim Form, and then give both to the employer.
- The employer has three working days to pass the Certificate and Claim Form onto their insurer.
- The insurer will notify the worker within 14 days after receiving your claim form. The notification will indicate if the
claim has been:
Accepted
If the injury prevents the worker from working, your employer must commence making weekly compensation payments. Payments will be made on your normal payday for the duration of the medically-certified period of the incapacity.
Disputed
If the claim is disputed, no compensation will be paid and the insurer will advise the worker of the reason. If the worker disagrees with the insurer’s decision, they can approach the insurer to re-evaluate the decision. If still unresolved, they should complete an application to resolve the dispute and submit it to WorkCover WA’s Dispute Resolution Directorate (DRD) for an independent review as soon as possible. If they do not apply to resolve the dispute, the insurer may consider the workers claim dismissed.
Held / Pended
On some occasions the insurer may put the claim on hold pending further information. The insurer then has another 10 days to make a decision on the claim. If the claim is still undecided after the 10 days have passed, the claim is deemed to be in dispute. The worker may lodge an application with the DRD to have the matter decided.
Assisting the insurer
The insurance policy will detail what an employer can expect from the insurer. The most crucial way an employer can assist the insurer in managing claims is by immediately providing them with any relevant information they obtain regarding an injured worker. The employer should involve them as soon as possible after the injury occurs.
Making payments
While the claim is being assessed
The employer may consider paying accrued leave to the injured worker (such as annual or sick leave). They should ask the injured worker first, make it clear this is not workers’ compensation, and that payment of accrued leave or sick leave is a voluntary option until a decision regarding liability is made. If the claim is approved, and payment from accrued sick leave entitlements has been made, these entitlements must be refunded to the employer by the insurer and recredited to the worker.
If the claim is accepted
The employer should begin workers’ compensation payments without delay, consulting with the insurer regarding the amount. Once payments begin, you are required to pay the worker in the usual manner and on their usual payday, unless notified by the insurer to cease payments. If you feel that you may be unable to pay an injured worker’s weekly payments in this manner, you should contact your insurer as soon as possible to discuss what options are available. If you cannot resolve the issue with your insurer, contact Advisory Services.
Implementing your injury management plan & return to work program
An employer is required to have an injury management policy setting out their organisation’s approach to injury management, and an injury management system describing the steps to be followed if a workplace injury occurs. An employer is also required to develop a return to work program for an injured worker unless the worker has total capacity to return to their pre-injury position.
For more information and templates, see the injury management systems and return to work programs pages under the Returning to Work channel.
The Employer must keep the worker's position available
An employer is obliged to keep an injured worker’s position available during the worker’s incapacity. For more information, see the obligations of the key parties page under the Return to Work channel.
