Workers compensation claim form

Claims for compensation should be made using the new Workers compensation claim form which was introduced on 1 July 2014. The completed form should be provided to WorkCoverSA’s claims agents or WorkCoverSA. Alternatively, this information can be provided by telephone.

Workers of self-insured employers should provide this information to their employer in accordance with their procedures.

Our short animated tutorial provides a step-by-step demonstration of how to complete the claim form so that your claims agent obtains the information needed to help assess your claim.

Where does this information go now?

Employers Mutual
Phone: (08) 8127 1100 or toll free 1300 365 105
Fax: (08) 8127 1200
Post: GPO Box 2575, Adelaide SA 5001

Gallagher Bassett
Phone: (08) 8177 8450 or free call 1800 664 079
Fax: (08) 8177 8451
Post: GPO Box 1772, Adelaide SA 5001

Workers of self-insured employers should provide this information to their employer in accordance with their procedures.

Further information on completion of the claim form

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 seven calendar days (in most cases) but weekly payments will be limited to 13 weeks and medical and other expenses will be limited to $5000 (indexed annually). 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.

WorkCover Medical Certificate

(previously known as the Prescribed Medical Certificate - PMC)

WorkCover medical certificates are written by legally qualified medical practitioners in relation to an injury sustained during the course of employment. There are currently two valid names for medical certificates that are acceptable for use, a Prescribed Medical Certificate (PMC) and a WorkCover Medical Certificate (WMC). The name PMC is being phased out with the introduction of the WMC from 1 January 2009, because this form will no longer be prescribed. However, the contents of both the PMC and WMC remain the same. For the purposes of this website, all reference will be made to the medical certificate as the WMC.

In South Australia WMCs can be lodged in electronic or paper format.

Electronic WMC (eWMC)

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. 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:

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.

Features, tips and techniques

For additional WMC information read features, tips and techniques.

Electronic WMC via this website

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 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.

Paper WMC

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.

Contact details

For any enquiries regarding eWMCs please contact:

400 King William Street
Telephone: 13 18 55

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