What to do when a worker is injured

If a worker reports an injury to you verbally, you should request that it be made in writing by the worker filling in a Claim form. The Claim form can be used for two purposes:

• to report a workplace injury and/or
• to seek compensation payments.

There is a box provided for each purpose, and the worker (or their representative) should tick the corresponding box to indicate which action they wish to take.

A worker should report an injury or illness to you either verbally or in writing within 24 hours, whether they intend to make a claim for workers compensation or not.

You can assist your worker by ensuring they fill in as much information on the Claim form as possible.

You must notify Employers Mutual within five working days of receiving a report from a worker about a work-related injury or illness.

The easiest way to report an injury and start the claims process is by phoning Employers Mutual on 1300 365 105.

Example: Reporting an injury

Josie Nichols, is the owner/manager of Classic Hair a small hairdressing salon in Adelaide's eastern suburbs. Josie employs a part-time hairdresser, David, and Marie, a second year apprentice.
David developed dermatitis on his hands from handling products used in the salon. Josie rang Employers Mutual on 1300 365 105 to report the incident and advised him to see a doctor.
Upon return, David was able to continue working his usual hours but on the doctor's advice (written on the WorkCover Medical Certificate), he was not able to handle any chemical-based products in the salon until the dermatitis cleared.

Josie completed an Employer Report Form and promptly sent this with the Claim form and an original of the WorkCover Medical Certificate to Employers Mutual. She kept an original copy for her own records.

As a result of this claim, Josie has instructed her staff to use the protective gloves supplied whenever they are handling chemical products, such as hair dyes. Josie also spoke to David's doctor about best practice care for dermatitis and adopted those practices in her salon to help David recover, and reduce the risk of further injury to everyone.

For more information on injury reporting view the Employer FAQs or contact us.

The sooner your worker’s claim is lodged, the earlier you can start planning their return to work. The process is the same as if you were reporting the injury - except the worker (or their representative) should tick the box on the Claim form that indicates they are seeking compensation. You can assist your worker by ensuring they fill in as much information on the Claim form as possible.

You are required to notify Employers Mutual within five working days of receiving a claim, and you must ensure the following documents are submitted along with the Claim form :

• a WorkCover Medical Certificate – which the doctor will give to the worker
• an Employer Report Form – which you can get from Employers Mutual.

Note: You may be financially rewarded by not being required to pay the first two weeks of wages if you provide a copy of the Claim form, WorkCover Medical Certificate and an Employer Report Form within two business days. Click here to learn more about incentives for early reporting.

You will also be asked to provide wage details of the worker, so Employers Mutual can calculate the amount the worker should be paid to replace the income they would have earned.

You cannot legally refuse to report a claim by a worker. Employers who delay the reporting of a claim may be penalised.

Where do I get the claim form?

You can download the Claim Form here or get them from:

• WorkCoverSA's Service Centre on 13 18 55
• Employers Mutual, phone 1300 365 105
• www.employersmutual.com.au
• your local post office.

Tip

Keep claim forms at all of your business locations so they're available if there is a workplace accident.

Provisional Liability (provisional payments)

The concept of provisional liability was introduced on 1 January 2009 to enable a worker, who has a work-related injury or illness, to continue receiving an income in the form of provisional weekly payments for up to 13 weeks ⁽¹⁾ or until such time as their claim is determined.

Provided all mandatory information has been submitted, and provided a 'reasonable excuse' for not commencing payments does not exist, WorkCover or the self-insured employer will commence making weekly payments to an injured worker within seven calendar days of the injury being reported.

Under provisional liability, an injured worker may also request payment of medical and other expenses up to a total of $5,000 ⁽²⁾. There is no time limit in which these expenses can be incurred, as long as the $5,000 limit is not exceeded. If the worker has paid for necessary medical treatment, Employers Mutual or the self-insured employer should reimburse the worker within 14 calendar days after the worker requests payment or in accordance with the self-insured employer’s policies and procedures.

To help start provisional payments within seven days, employers and employees should provide all the necessary information to WorkCover. Employers, who refuse or are unable to provide wage information, may not be eligible for a waiver of responsibility to pay the first two weeks of wages.

The acceptance of liability on a provisional basis does not constitute an admission of liability by the employer or WorkCover. Each claim still needs to be determined.

^{1 - Providing that the circumstances of the case do not meet one of the 'reasonable excuses' defined in the Provisional payment guidelines published by the Minister for Industrial Relations.
2 - A claim for reimbursement of medical and other expenses will be made in the manner nominated by Employers Mutual or the self-insured employer}

Mandatory information

WorkCover and self-insured employers require a minimum level of information to be able to start paying weekly payments or medical expenses. Minimum (mandatory) information is defined in the Provisional Payment Guidelines, which is published on the WorkCover website. The mandatory information is clearly marked in shaded boxes on the Claim form.

Note: Workers are required to provide a Claim form as well as a WorkCover Medical Certificate (formerly known as the Prescribed Medical Certificate) as part of their mandatory information.

Reasonable excuses

Payments can be refused if there is a reasonable excuse to not commence payments. 'Reasonable excuses' have been defined in the Provisional payment guidelines, which can be downloaded below.

Provisional payments guidelines [78 KB]

Helpful links

Provisional liability fact sheet [116 KB]

Once a claim has been lodged you will be assigned a case manager by Employers Mutual. Your case manager will determine if your worker is eligible for workers compensation and you can expect them to: 

• contact you to discuss your workers case
• manage your workers claim for compensation
• give you the information you need about rehabilitation and Compensation
• contact health professionals where necessary
• manage and coordinate your workers rehabilitation and return to work
• give you information about health and safety at work.

They will also work with you and your worker to determine their entitlements and ensure your obligations are met under The Workers Rehabilitation and Compensation Act 1986.

You can also expect to get letters about a variety of things associated with your worker's claim from your case manager – talk to them first if you have any queries or don't understand something.

Now that a claim has been submitted you will also need to:

• pay the first two weeks of weekly payments to your injured worker
• take steps to prevent further workplace accidents
• identify and offer suitable employment to your worker

If a worker is off work they may need to receive weekly payments to replace the income they would have earned if they were at work. Usually, an employer is required to pay the first two weeks of weekly payments, but if you report the claim early you may be financially rewarded.

Financial reward

You may not have to pay the first two weeks wages if you report the claim and provide the appropriate documentation within two business days. If this is the case, WorkCover will make or reimburse you the payments – saving you money.

However, if you do not report the claim within two days, you must pay the first two weeks of weekly payments yourself. If the worker is off work for longer than two weeks WorkCover will cover the cost. You may choose to keep paying them in line with your pay cycle. In some cases, we may agree to pay the worker direct.

Determining a claim

If you have a workplace injury, your case manager will be responsible for determining a claim – ie, deciding if weekly payments will commence and medical expenses will be paid. Decisions will be made, in most cases, within seven days. However, if a decision cannot be made in that time, WorkCover may begin making weekly payments anyway so that the focus is on rehabilitation and return to work rather than concerns over payments.

If one of your workers is injured at work, you can choose to pay weekly payments of compensation at the rate determined by the claims agent to the worker and obtain reimbursement from WorkCover where you are entitled to do so. This can be an important tool in maintaining a relationship with your workers while they are not at work due to injury. This process is managed through employers submitting a weekly payment reimbursement request (WPRR). 

Weekly Payment Reimbursement Request form [388 KB]

You can also get forms from your worker’s case manager or by calling WorkCover’s Service Centre on 13 18 55. 

You will need to keep details of when an injured worker works and how much they are paid. When you complete this form, you record the payments week-by-week starting on a Sunday and ending on a Saturday. For example, if your pay week is from Wednesday to Tuesday, you need to report to us the period highlighted in the example below, and enter that on the form as a total for that week. 

Copies of your pay records (eg, payslips) must be attached to each form to assist with validating and processing your request. 

It is important for you to know that a worker is entitled to receive both their workers compensation entitlement and any industrial leave entitlements.  So if a worker takes any leave for which they are paid they will receive this on top of their weekly payments – there is no adjustment to the weekly payments for paid leave. For example, if a worker is totally off work and receiving $500 of WorkCover weekly payments and they take an annual leave day, they will be paid their usual weekly payment of $500 (for which the employer will be reimbursed) and receive a payment from their employer for their annual leave day as well if they are entitled to a leave payment.  Please bear this in mind when completing a WPRR. 

Please ensure that you submit forms as soon as possible – submitting forms in a timely manner means you will be reimbursed more quickly. 

WorkCover is currently developing an online reimbursement system, to be launched in 2012.

There is more information on the form about how to complete it.  If you need any help, please speak to the case manager managing your injured worker’s claim.

Once an injury has occurred, you and your workers should work together to review your workplace safety systems to prevent further accidents.

There are a number of simple, yet effective ways to make your workplace safe, including the following:

• Inspect the workplace to identify potential hazards. This should include checking all accident and incident reports.
• Prioritise work tasks that present the greatest risk of injury and develop safe work procedures for them.
• Regularly review your safe work procedures to ensure they are current and effective.
• Regularly consult with staff on ways to eliminate or reduce the risks arising from hazards.
• Provide your workers with appropriate induction, training and supervision to ensure they can carry out their tasks safely.

Help for small-to-medium enterprises
An information pack titled Serious about safe business has been specifically designed to help small-to-medium businesses to achieve compliance with OHSW legislation. The pack contains tools to help you identify what they need to do to make your workplace healthy and safe, and outlines how to do it. The pack is available on the SafeWork SA website.

For more information about SafeWork SA and your responsibilities as an employer contact:
SafeWork SA’s Help Centre
Phone: 1300 365255
Email: help@safework.sa.gov.au
www.safework.sa.gov.au

Once the doctor has given your worker permission to return to work, you are obligated to find suitable employment for them. Failure to provide suitable employment may result in prosecution with a fine of up to $25,000. Suitable employment is work that a worker can do, taking into account their injury, their previous employment, their age, education, skills and work experience, and where they live.

Identifying appropriate work for an injured worker might seem a little daunting, but your case manager will help, as will the doctor (to give advice on capability and restrictions) and in some cases, a ocational rehabilitation provider, who may visit the workplace to assess work opportunities. If you have a return to work coordinator they will help too.

Identifying suitable employment

Here are some things you can consider that might help.

1. Medical information. What does the WorkCover Medical Certificate say? Is there something your worker can do within their restriction?
2. Modified duties. Consider modifying your worker's usual job – what parts can they do within their medical restrictions? Could they safely perform some or all of their normal duties with assistance (eg, special tools, aids or a buddy system)?
3. Alternative duties. If they can't do their old job, are there any other duties available that your injured worker may be able to safely perform? Is there any other work that needs to be done in your workplace that they could do?
4. Think about the whole person. How does your worker's age, education, skills, work experience and personal circumstances impact upon their return to work? Consider whether this makes them suitable for performing duties other than those they used to do before they were injured. Also, think about where they live. Has the injury impacted upon their ability to get to and from work? Will they require travel assistance to help them return to work?

Offering suitable employment

Once you have considered all the information and identified suitable employment you should discuss this with the worker and your case manager. If no duties are available or identified, you will also need to contact your case manager.

Obligations on employers and workers

Under the Act workers and employers have responsibilities to assist the return to work process.

Injured workers are obliged to accept and undertake suitable employment offered by their employer, and for which they have been certified medically fit by their doctor. If a worker resigns, refuses to work, or demonstrates an unwillingness to work, they risk losing their income maintenance (WorkCover payment).

Likewise employers are obliged to provide suitable employment. If an employer fails to cooperate with the implementation of a rehabilitation program, or fails to provide suitable employment, they risk being charged a supplementary levy by WorkCover.

For more information view the Employer FAQs on this subject, contact us to make an enquiry or phone our Service Centre on 13 18 55 for advice.