Forms

A WorkCover Claim form can be used to notify a workplace injury or seek compensation payments if you have been injured at work with an employer registered in South Australia. Alternatively, this information can be provided by telephone to Employers Mutual or the self-insured employer.

Receiving this information will enable a request for compensation to be considered and will provide sufficient information for the case manager to assist in the return to work process.

If there is insufficient space provided for any of the questions, please attach additional information. A copy of this form should be kept for your records.

Download a copy of the claim form [224KB]

• An injured worker
• An employer*
• A representative, such as a treating doctor, first aid officer or a worker’s relative or friend

It is important to ensure that the employer is notified (if you are not the employer) and has also been provided with these details if you are notifying Employers Mutual directly (unless the worker is not in employment at the time of injury).

* An employer may complete this form to notify of an injury or begin the claim process, however they may be asked to complete an Employer Report Form if the claim will be ongoing after 13 weeks and additional information is required.

The information in this form can be provided to:

Employers Mutual
By phone: 1300 365 105
By fax: (08) 8127 1200
By post: GPO Box 2575, Adelaide SA 5001
Online at: www.employersmutual.com.au

OR

Self-insured employer
In accordance with the procedures issued by the individual employer.

Hard copy forms are available from WorkCoverSA, Post Offices and Employers Mutual.

A notice of injury only under section 51 of the Workers Rehabilitation and Compensation Act 1986 (the Act) means that you wish to give written notice that an injury has occurred, but do not request any compensation payments at this time. If, at a later date, you wish to claim compensation (weekly payments and/or other expenses) you will need to lodge a claim for provisional payments under Division 7A or section 32A of the Act (provided it is within the first 13 weeks since the injury) or section 52.

A notice of an injury and request for provisional weekly payments means that you seek weekly payments of compensation (under Part 4, Division 7A of the Act) and/or medical and other expenses (under section 32A). Provisional payments under these sections will start within 7 calendar days (in most cases) but weekly payments will be limited to 13 weeks and medical and other expenses will be limited to $5000. If payments are likely to exceed these limits, you are entitled to make a claim for compensation under section 52 of the Act, even if you have already given a notice of injury and sought provisional payments. If a claim for compensation is made under section 52 of the Act, payments will start if and when the claim is accepted. This covers ongoing weekly payments and medical and other expenses. If you wish to make a claim for compensation under section 52, please contact your case manager.

In conjunction with medical software vendors, WorkCover has developed an electronic WorkCover Medical Certificate (eWMC) which allows a simple electronic process that integrates with the doctor’s business practices. The eWMC is saved directly to the patient database and securely emailed to WorkCoverSA for processing. A fee is paid for each eWMC received via the gazetted email format. This process reduces the number of printed copies of the WMC the patient will require; when a doctor utilises this electronic process, the patient will require two (2) hard copies of the WMC (one for the patient/worker and the other for their Employer) compared to the standard three (3) copies with the original paper version. Please note that each printed copy is identical.

For providers who do not want to use the email facility, an additional WMC can be printed from the patient's record and given to the patient, providing them with three (3) hard copies as with the original paper version.

The following medical patient software applications contain an eWMC function:

• Medical Director
• Medtech
• Zedmed
• Genie
• Best Practice
• Direct Control

Contact your software vendor for installation instructions. Their contacts details are:

• Medical Director Help Desk on 1300 788 802
• Medtech's Helpdesk on 1800 148 165
• Zedmed on 1300 933 000 or email sales@zedmed.com.au
• Genie Solutions' South Australian Agent on 7127 1440, visit www.geniesolutions.com.au or email genie@konos.com.au
• Best Practice on (07) 4155 8800 or email detailes to support@bpsoftware.com.au
• Direct Control on 300 557 550 or email details to support@directcontrol.com.au

The South Australian eWMC takes advantage of software developed for the Health Insurance Commission’s Public Key Infrastructure and utilises a digital certificate issued by the Health eSignature Authority (HeSA). WorkCover utilises a private key to unlock the eWMC. If we cannot open the eWMC using this key, we know the eWMC has potentially been tampered with and we will contact you directly. This process ensures security in transmission.

Note: WorkCover's public key must be installed on your computer using the instructions provided to you by your software vendor. If this key is not installed you will not be able to email the eWMC to WorkCover.

The next expiry date is 17 April 2009. At this time a new certificate will need to be installed into your software to enable your practice to continue to use the eWMC email facility. Contact your software vendor for advice and instructions detailing the upgrade process.

For additional WMC information read features, tips and techniques.

To use the eWMC facility within WorkCover's website you need to obtain a unique username and password. Complete the WMC application form and return it to us. We will contact you with your unique login details.

You can lodge a form directly from this website using the following link: Enter the eWMC.

Note: A completed WMC does not mean that a claim has been made. A worker must also lodge a claim with their employer or WorkCover in order to have his/her claim processed. Claim forms are available from workplaces, post offices, WorkCover or www.workcover.com or claims can be lodged via telephone by the worker or their representative (including their doctor) by calling WorkCover on 13 18 55 or their claims agent Employers Mutual on 1300 365 105.

The pad version is for those doctors who wish to continue to hand-write WMCs. If you use this method WorkCover will not pay you a fee. Requests for pads of WMCs must be in writing on letterhead stating the name and provider number of the doctor. These requests can be posted to WorkCover or faxed to (08) 8233 2466.

For any enquiries regarding eWMCs please contact:

WorkCoverSA
100 Waymouth Street
ADELAIDE SA 5000
Telephone: 13 18 55