How To Make WorkCover Claims
As part of the NSW Workers Compensation Legislation, if you have sustained an injury in the course of your employment in NSW, you have a right to make a WorkCover claim for compensation.
Notify your employer
The first step in claiming WorkCover compensation for a work-related injury is to notify the employer and insurer of that injury.
A worker must tell their employer as soon as possible after the injury happens that they have sustained an injury in the course of employment. A worker can notify their employer verbally or in writing.
The employer must keep a register of injuries in the workplace for the injured worker to complete. When an employer becomes aware of the work-related injury, they must notify the insurer within 48 hours.
If the employer does not notify the insurer, this notification can be made by the worker. Notification to the insurer of the injury can be by email or by phone.
If the employer does not tell the insurer about the injury, then the worker should ask the employer for the insurer’s name and details. If the employer will not give you the name of the worker’s compensation insurer, the worker can phone the SIRA Customer Service Centre on 13 10 50 to discuss their WorkCover claim.
Give to your employer a WorkCover Certificate of Capacity
At the same time of notifying the employer of the injury, a worker should provide to the employer (and the insurer) a WorkCover Certificate of Capacity. This certificate is obtained from your general practitioner and outlines your fitness for work and what treatment a worker needs for their injury.
What happens next?
Once the insurer receives a notification of injury and the WorkCover Certificate they must either:
- Start provisional weekly payments within 7 days; or
- “Reasonably excuse” paying provisional weekly payments on the basis that insufficient information has been provided about the injury and claim.
If the insurer “reasonably excuses” the claim, then the insurer has 21 days to make a decision as to whether they accept or decline liability from the date that a worker’s compensation claim form is completed and sent to the insurer.
Once provisional weekly payments/medical expenses have commenced, the insurer will then investigate the claim and decide as to whether they will formally accept the claim or decline liability.
If the insurer intends to decline liability for a WorkCover claim, they must do so in accordance with Section 74 of the Workers Compensation Act. This requires the insurer to provide written notice of the reasons and evidence which the insurance company relies upon to decline the claim.
If you need assistance with your WorkCover claim, please do not hesitate to contact us as follows;