Who pays my wages during the time that I am on workers compensation?
Generally, the first two weeks of your salary are paid by the employer. After this date if you are still being paid income maintenance, your employer will be reimbursed by WorkCover. In some cases, the claims agent will pay you direct.

I was about to go on leave before I got hurt, what happens to WorkCover payments if I go overseas or interstate?
The Act lays down conditions about travel out of South Australia. While this does not mean that you cannot leave the State, you must discuss this with your case manager prior to leaving the state.

Is my usual overtime calculated as part of the WorkCover payment?
Income maintenance payments are based on the amount the injured worker earned in the 12 months preceding the disability. This includes basic wages, overtime (if overtime was likely to have been ongoing), allowances and non-cash benefits not retained (such as a motor vehicle).

I am a casual worker, how is my average weekly earnings calculated?
Your average weekly earnings will be based on the amount you earned in the 12 months preceding the disability. This can be complex if you have had fluctuating earnings and your case manager will discuss this with you before making a decision.

I had a work car as part of my package. Is this calculated in my weekly compensation payments?
Amounts such as this will be included on the basis that it formed part of the amount that you earned in the 12 months preceding the disability.

Is my uniform allowance included in the rate you pay me?
The legislation provides for the exclusion of prescribed allowances. However no allowances have been prescribed to date so all allowances are included in the calculation of your average weekly earnings.

I was about to retire before I got hurt. What happens with my pension?
A Commonwealth Government aged pension is payable on the basis of age. In general, therefore as set out in the Workers Rehabilitation and Compensation Act, workers compensation payments cease at the time you would have normally retired. Medical expenses relating to the injury may be payable after retirement.

Do workers compensation payments affect my partner's income tax?
For taxation purposes, workers compensation payments are income. WorkCover can't give advice about your taxation obligations - you should approach the Australian Taxation Office.

Do I receive a payment summary (group certificate) for compensation payments?
Yes, you will receive a payment summary for your income maintenance earnings.

I am employed by more than one employer. Will your sum take this into account?
The average weekly earnings calculation will take into account all income earned as a worker.

My apprenticeship was nearly up at the time I was injured. Do you calculate based on my rate as an apprentice or as a qualified tradesman?
If you are permanently incapacitated, the average weekly earnings amount is calculated as if you had completed your apprenticeship. If your incapacity is not permanent, the average weekly earnings amount is based on what you were receiving at the time of the disability.

Do I claim costs on Medicare or on my own private health insurance?
If you have already been reimbursed for medical costs by Medicare or private health insurance, you need to tell your case manager about it. Medicare or a private health insurance company may seek reimbursement from WorkCover for these expenses. All claims-related costs must be directed through your case manager.

Do I ever have to pay for my own medical bills?
If the claim has been accepted, all costs reasonably incurred by the worker as a result of having suffered a compensable disability will normally be paid. Reasonable costs will be determined by the claims agent. Although the Act does not define the term 'reasonably incurred', it means that the worker acted reasonably in obtaining the service and in engaging themselves to pay the amount charged.

A worker is not obliged to choose the cheapest or most conventional available treatment, and generally speaking where a worker acts upon apparently reputable medical advice, the worker will be considered to be acting reasonably even if the advice is wrong or incompetent.

However where a worker incurs a cost for a service which the worker knew would be of little or no benefit, or where the same benefit could have been obtained much less expensively, the worker may not be considered to have acted reasonably in procuring the service and undertaking to pay the cost.

When do I need a solicitor to deal with my claim?
Usually only if you have an unresolved dispute with the claims agent/WorkCover. You may also be eligible for support through your union.

Can I get a copy of my claim file?
Under the Freedom of Information Act (FOI) you can apply to see or ask for a copy of your records. There may be some documents that this does not apply to. There are prescribed fees that apply but they may be waived in certain circumstances (ask if the fees can be waived). You can also apply under section 107B of the Workers Rehabilitation and Compensation Act 1986 for access to your records, which is free. Our website has the forms needed for this process (browse documents A-Z and see under 'F' and 'S').

Does WorkCover pay for using an advocate if the worker needs assistance eg, if they have an intellectual disability?
WorkCover's Service Improvement Unit is available for people who need advice with regard to disputing a decision. If an independent advocate is needed to assist on other matters, we would provide the person with information on disability advocacy services.

WorkCover continues to provide advice to injured workers and employers on entitlements, claim decisions, disputes and scheme navigation through the Service Improvement Unit. Call 8233 2463 for free, confidential advice.

The delivery of advocacy and representation services on behalf of injured workers are now provided by SA Unions and Business SA.

I live in rural SA, what support can you offer me?
Regardless of where you live, the level of service you receive should be the same. In remote areas, you may have to travel to receive some services and WorkCover will pay for such travel.

What do I do if I'm not happy with my case manager?
If you have a complaint about the way you are being treated by your case manager, approach their team leader or manager with details. If you are still not satisfied, approach WorkCover's Service Improvement Unit to make a complaint on 13 18 55 or mail to GPO Box 2668 Adelaide 5001 or email SIU@workcover.com.

It seems like everyone has access to personal information about me. How is it controlled?
The Act is very specific about disclosure of information. WorkCover and our claims agent have strict policies about who is entitled to access information. Other providers are also bound by the Workers Rehabilitation and Compensation Act and the Privacy Act.

Can I sack someone while they're away from work on workers compensation payments?
When a worker is injured at work, the employer must provide alternative duties (where possible) and work cooperatively with the claims agent. In certain circumstances a worker's employment can be terminated but you should seek advice from your claims agent before doing so.

Who pays the first two weeks' wages and is there a time limit to pay this?
An employer’s liability is to pay the first two (2) weeks of income maintenance, this may be waived if the employer notifies the claims agent within two (2) days of having received the claim.

What happens if the worker has more than one employer?
A worker in this circumstance is entitled to all income earned as a worker.

Are superannuation payments included in average weekly earnings calculations?
Any contribution paid or payable by an employer as part of a salary sacrifice arrangement between the employer and employee to a superannuation scheme are included in the average weekly earning calculation.

Is annual leave and leave loading included in WorkCover weekly payments?
Under the Workers Rehabilitation and Compensation Act, both annual leave and compensation may be paid for the same period during the first year of incapacity. After the first year, the worker is deemed to have taken any annual leave that might otherwise have accrued. Leave loading is the responsibility of the employer.

Do you treat contractors the same as other workers when calculating their weekly earnings?
Yes, providing they were working under a contract of service. However, this issue is complex and you should seek direct advice from your claims agent.

How do we deal with long-service leave if someone is on WorkCover?
A worker is entitled to be paid long-service leave in addition to being paid income maintenance for the same period for the first year of incapacity. If the incapacity continues for more than a year, whether long-service leave will continue to accrue or not would probably be governed by any award that may apply. The employer is responsible for paying the long-service leave wages.

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 types of 'journey' claims are only covered by WorkCover in South Australia for a work-related journey. If you leave home and travel straight to work and have an accident, generally you are not covered. However, all cases are individually analysed and determined 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?
There are time limits (normally six months from the date you first need time off or incur expenses as a result of an injury.) If you lodge a claim outside that timeframe, and the case manager rejects it based on it being lodged late, you may have to appeal to the Workers Compensation Tribunal if you feel you have a valid reason for the late lodgement.

What do I do after I get my PMC?
PMC is now WMC (WorkCover Medical Certificate).

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.

Can I choose my own doctor if I have time off work or make a claim?
Yes, you can choose your own doctor and/or treating specialist. The only time the case manager can specify which doctor you see is if they arrange an independent medical examination for you.

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. We 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 on behalf of WorkCover or a self-insured employer under the Act.

Can I be sacked for making a claim?
Legally, you can't. 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 there is no obligation under the Act for you to disclose a previous claim. It is up to you whether or not to disclose the information.

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's longer since you were injured you can still lodge a claim, but the claims agent 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.

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 WorkCoverSA. 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.

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.

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 WorkCoverSA. 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 needs to give you a Notice of Disability where an injury occurs and if necessary, a claim for compensation. If a claim for compensation is lodged, you must also complete an Employer Report Form and send that and the claim to your claims agent. You should keep copies of all such notices and also copies of any correspondence relating to the matter.

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 a claim is accepted?
The case manager, acting on behalf of WorkCover or a self-insured employer under the Act.

How long does it take to determine a claim?
The claims agent generally must make a decision about whether the claim is accepted or rejected within 10 business days from receipt of the claim (unless further information is needed). In some cases the claims agent may defer the decision and may pay the worker interim income maintenance in the meantime. If the claim is eventually rejected, the worker will have to pay back this money.

What happens if there is a delay in determining a claim?
If a claim has not been determined within a reasonable period, (which will depend on the circumstances), the worker or employer can apply to the Workers Compensation Tribunal for an expedited decision. The agent may pay interim income maintenance in the meantime.

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. We take fraud seriously and thoroughly investigate allegations received to protect the integrity of the Scheme and people's confidence in it.

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.

Does the agent have to accept the claim?
All claims must be determined and the claims agent will advise all parties of the result, whether it is to accept or reject a claim.

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.

Will my weekly payments affect my partner's Centrelink payments?
If your partner is receiving Centrelink payments, they should tell Centrelink if you are receiving weekly payments of compensation because of a work injury or illness.

My workmate was injured. Now that he's coming back what support should we offer him?
Your employer (and your workplace) has a responsibility to cooperate in the process of rehabilitating your workmate. You should also be aware of how disabilities affect people's capacity to work but you should also respect your workmate's privacy.

A family member was injured at work. Is there anything we can do to help him?
Be understanding about how the injury is affecting him. If the family member is willing, you could attend medical appointments with him.

Do you offer social support or counselling for people who work with someone who died at work?
WorkCover generally does not fund this type of support as it only pays for expenses that were incurred by the worker. The employer may offer some support, particularly if your health and safety representative requested it.

Do you offer social support or counselling for people who work with someone who died as a result of a suicide?
WorkCover generally does not fund this type of support as it only pays for expenses that were incurred by the worker. The employer may offer some support, particularly if your health and safety representative requested it.

Why are there so many people involved in my case file? What do they all do?
Generally, you will have only one case manager who coordinates all activity on your claim. There are many people who provide services and support if you are injured at work though. For an alphabetical list of individuals or organisations view return to work roles.

Can I bring a representative to a meeting about my claim?
Yes, you are entitled to bring a support person to any meeting about your claim.

Can I get a copy of my claim file?
Under the Freedom of Information Act (FOI) you can apply to see or ask for a copy of your records. There may be some documents that this does not apply to. There are prescribed fees that apply but they may be waived in certain circumstances (ask if the fees can be waived). You can also apply under Section 107B of the Workers Rehabilitation and Compensation Act 1986 for access to your records (this is free). Our website has the forms needed for this process (browse documents A -Z and see under 'F' and 'S').

What do I do if I'm not happy with my case manager?
If you have a legitimate complaint about the way you are being treated by your case manager, approach their team leader or manager with details. If you are still not satisfied, approach WorkCover's Service Improvement Unit to make a complaint on 13 18 55 or mail to GPO Box 2668 Adelaide 5001 or email SIU@workcover.com.

What do I do if I'm not happy with my rehabilitation and return to work plan?
You will be consulted on the content of the plan and asked to sign off on it, so make sure you understand it first. However, you are not legally obliged to agree with the plan and if you have a legitimate complaint, you can appeal to the Workers Compensation Tribunal about your concerns. Once the case manager has approved the plan, the obligations and responsibilities listed on it are binding.

When do I need legal representation?
Usually only if you decide to appoint one because of an unresolved dispute with Employers Mutual/WorkCover or your self-insured employer. You may also choose to be supported through the SA Unions workers compensation advisory service - contact SA Unions on 8279 2222 for information. (You don't need to be a union member).

Further information
The first point of contact for any specific queries should always be your case manager. However, you may also seek information from WorkCoverSA by calling 13 18 55 or visiting www.workcover.com.

Our fact sheet Who does what in the workers compensation system has detailed information about organisations that may be useful and descriptions of parties involved. Our fact sheet Help when you're not satisfied has detailed information about disputes and complaints.

You can get these and other fact sheets by:

• asking your case manager
• downloading them from the website
• calling WorkCoverSA on 13 18 55.

Are workers over the retirement age eligible for workers compensation in South Australia?
Yes, South Australian workers over retirement age are eligible for workers compensation for a limited time period.

For workers over retirement age what can they claim for?
Workers over retirement age can lodge a claim for compensation. Once lodged, their claim will be assessed and if accepted, reasonable medical treatment and costs can be paid or reimbursed (eg, ambulance, hospital and health care expenses, medicines, travel to and from medical appointments, therapeutic appliances and nursing).

For how long is a worker who is over retirement age entitled to receive weekly payments of compensation?
If a worker is within two years of retirement age or over retirement age when they were injured at work and they are incapacitated for work while still in employment, weekly payments may be paid for the period of the incapacity for up to two years from the date of the commencement of their incapacity.

Note: For a worker receiving weekly payments for an incapacity that commenced more than two years before their retirement age, their weekly payments will be stopped when they reach retirement age.

How is retirement age defined?
The South Australian Workers Rehabilitation and Compensation Act 1986 (the Act) defines retirement age as follows:

• if there is a normal retirement age for workers in employment of the kind from which the disability arose – that age of retirement, or
• age 65 years,

Who do I contact for more information?
If you need help, speak to:

• A supervisor
• The employer’s rehabilitation and return to work coordinator
• A union representative
• An occupational health and safety officer/representative
• Employers Mutual on 1300 365 105
• WorkCoverSA on 13 18 55.