Compensation and lodging a claim FAQs - Workers
Compensation and lodging a claim FAQs - Employers
Compensation and lodging a claim FAQs - Workers
I'm a casual worker - am I still covered for workers compensation?
Regardless of a worker's status (ie, full-time, part-time or casual), if they are determined to be workers under the Act they are eligible for compensation if they are injured or become sick because of their work.
What happens if I am hurt at work but my employer isn't registered with WorkCover?
Workers are covered regardless of the employer's status with WorkCover.
If I am hurt on the way to work, is this covered?
These are known as 'journey claims' and are not usually covered by workers compensation in South Australia. If you leave home and travel straight to work and have an accident, generally you are not covered. However, all cases are individually analysed by the case manager.
If I am hurt at work, but I was drunk, is this covered?
Generally, if you were drunk at work and it is reasonable to believe that the injury is attributable to your intoxication, your claim will be rejected. This includes all drugs other than those that are legally prescribed.
What should I do if I am hurt at work and my employer tells me not to make a claim?
All workers have the right to make a claim for compensation if they have been hurt at work. An employer cannot direct a worker not to claim for compensation as a result of being hurt at work. If this happens, contact WorkCover on 13 18 55.
Do I need to report an injury if I don't intend to claim?
You should report an injury even if you don't intend to make a claim because with the passage of time the injury could get worse. Reporting an injury also enables your employer to track (and fix) potentially dangerous tasks or equipment in the workplace. For more information view injury reporting.
Are there any time limits on when I can lodge a claim?
A claim for compensation needs to be lodged within six months of the disability arising, or within 13 weeks for payments to commence on a provisional basis. In some cases, you may be able to lodge a claim after the 13 week period.
Can my employer refuse to report a claim I have lodged?
Legally, they can't. If your employer refuses, you can still lodge a claim independently through WorkCover and you should tell WorkCover about this.
What information about my claim is kept on my employee record?
Employers must keep reasonable records of workers compensation matters but those records must be kept confidential, unless you give your permission to disclose personal information or permission is provided under the Act.
What happens if I require time off work?
If the doctor has determined that you are unable to perform your normal duties and/or require time off from work, they will issue you with a WorkCover Medical Certificate. You must provide this to your employer as soon as possible so that it can be forwarded to Employers Mutual to allow payments to commence or continue. All time lost must be covered by a WorkCover Medical Certificate.
Can I choose my own doctor?
Yes, you can choose your own doctor and/or treating specialist. The only time WorkCover can specify which doctor you see is if we arrange an independent medical examination.
Are claims investigated?
Not all claims are investigated. Investigations are often conducted to clarify or seek further information about a claim, or because an allegation of fraudulent behaviour has been received. Fraud can be committed by workers, employers and service providers. WorkCover take fraud seriously and thoroughly investigate allegations received to protect the integrity of the Scheme and people’s confidence in it.
Who decides if a claim is accepted?
The case manager, acting under the claims management agreement with WorkCover. For more information view acceptance of a claim.
Can I be sacked for making a claim?
Legally, you can't, but if this happens you should contact your case manager and/or seek independent legal advice.
Do I have to tell a new employer about a claim in a previous job?
If an employer asks whether you have previously made a claim for workers compensation, you have a responsibility to be truthful in your answer, however, there is no obligation under the Act for you to disclose a previous claim.
What if I was injured in a previous job but never claimed - can I still get my physiotherapy (or other medical bills) paid?
Under the Act, a worker is entitled to be compensated for costs reasonably incurred as a result of having suffered a compensable disability. This means you must lodge a claim and the Act says you must lodge it within six months of incurring the expense. However, if it is longer since you were injured you can still lodge a claim, but the Employers Mutual or a self-insurer employer will have to be satisfied the delay was reasonable and that they can still reasonably determine what happened.
I work for a self-insured employer, do I use the same forms to make a claim?
Yes, all claims are documented on the same forms regardless of who manages the claim and the associated costs.
How does a claim differ from ordinary sick leave?
Sick leave is for personal illness or injury - taking sick leave for a work injury may leave you liable for expenses that should be covered by compensation. The injury may develop to become more complex or costly. WorkCover helps claimants with access to professional health care resources and claims management to help you fully recover and get back to work.
Is my employer allowed to contact my doctor?
Your employer can contact your doctor but only to discuss how they can assist you to recover and return to work. Your employer can discuss your diagnosis or prognosis with your doctor and can only have these discussions with your permission via a ‘medical authority’ form, and you should only give permission for matters relating strictly to your claim to be discussed. You are not obliged to give such permission to your employer. Your doctor is bound by the Privacy Act (an Act of the Commonwealth Parliament) and can only disclose certain information in limited circumstances. For more information view workers rights and responsibilities.
Compensation and lodging a claim FAQs - Employers
Do you cover part-time/casual workers?
Regardless of a worker's status (ie, full-time, part-time or casual), if they are deemed to be workers they are eligible to claim compensation if they are hurt or made ill as a direct result of their work.
What happens if workers are injured outside of South Australia?
Each state and territory has its own workers compensation laws. If you are registered with WorkCover in South Australia and one of your workers is injured whilst working out of South Australia, they should lodge a claim with WorkCover SA. We will advise you if the claim will be met here or if the worker should lodge another claim with another state's jurisdiction.
Do you cover workers who are over 65?
Generally, workers compensation payments cease at the time a worker would normally retire. For most people this would be age 65 but in some circumstances it may be different. Medical expenses may continue beyond 65.
Am I covered as a self-employed person?
No, you will need to take out your own sickness and accident/income maintenance insurance.
Do you cover apprentices?
Yes, an apprentice is a worker and so is eligible to claim compensation if hurt at work.
Do you cover contractors?
Generally, where a worker is employed under a contract of service instead of a contract for service, they are considered to be workers for the purposes of workes compensation and are therefore eligible to claim if hurt at work. This is a complex issue and you should seek advice from your claims agent.
Do you cover work experience kids?
People doing work experience are generally not classed as workers and therefore are not eligible to claim compensation.
Do new workers have to disclose pre-existing injuries to us before we hire them?
There is no requirement in the Workers Compensation and Rehabilitation Act 1986 for workers to disclose this information, however as an employer you have the right to ask the question.
I have a part-time business plus full-time employment. Occasionally I hire staff on a contract basis. What responsibilities do I have for WorkCover for those contractors and when do I require self-insurance?
The answer to this question depends on the basis of employment for your contract staff. If they are working under a contract of service, you would need to pay a WorkCover levy for them. If they are working under contract for service, generally, you would not be responsible for them. However, this issue is complex and you should seek direct advice from the agent.
Do I need WorkCover for businesses that do not operate within SA but which might have employees going there from time to time?
Generally, we would expect these businesses to have workers compensation cover in their state of origin. However, in some circumstances it may be necessary to cover them in South Australia by paying a levy to WorkCover SA. This issue is complex and you should seek direct advice from the claims agent.
What records do I have to keep about injury reporting?
The worker will need to give you as much information as possible to enable notification for compensation payments to commence. You should keep copies of all information provided, including any internal incident reporting documents and any other correspondence relating to the matter. For more information on injury reporting see the injury and return to work section.
What happens if I lodge the paperwork late?
You may be fined up to $1,000 and/or have a supplementary levy applied.
Who decides if payments will commence and medical expenses will be paid?
The case manager, acting under the claims management agreement with WorkCover. This decision is based on the guidelines set out in the Injury and Case Management Manual, which interprets how legislation is to be applied in this area. Detailed information on the claims process is provided in the injury and return to work section of this site, which also contains FAQs from workers and employers on this subject.
Is there any advantage in reporting a claim quickly?
An employer has a legislative obligation to report a claim for compensation to WorkCover within five days of receiving notice from a worker. To encourage the early reporting of a claim, an employer will be rewarded if they report a claim within two (2) business days, through a waiver of their responsibility to pay the first two weeks of wages (South Australian employers usually cover an injured worker’s first two weeks wages). See incentives for early reporting for more information.
How long does it take to determine a claim?
Decisions will be made, in most cases, within seven days of Employers Mutual or the self-insurer being notified of a workplace injury by telephone or by receipt of the claim form containing the mandatory information. Payments will only commence once Employers Mutual or the self-insurer have the necessary information required, this includes any requests for additional information.
What happens if there is a delay in determining if compensation will be paid?
If a determination has not been made within a reasonable period, (which will depend on the circumstances), the worker or employer will be advised in writing with the options available for the worker and employer if they are not satisfied with the delay. See complaints and disputes for more information.
Are claims investigated?
Not all claims are investigated but WorkCover and/or case managers will make a decision on compliance-related issues on a per case basis. Fraud costs the community through higher workers compensation levies, lower profits for employers, lower wages for workers, lost jobs and higher prices for goods. To make an allegation view the fraud section.
What happens if a claim is false?
If WorkCover is satisfied that a claim is dishonest, the person who committed the offence may be prosecuted.
Do work-related claims have to be witnessed by anyone?
The Act does not require a witness although the question is asked on the claims form.