What is Workers’ Compensation?
Workers’ compensation is a type of insurance (paid by the employer) which supports workers who are injured at work. It covers medical costs and provides income support, as well as helping workers to safely return to work after an injury or illness.
Workers’ compensation in Australia is predominately jurisdictionally based, with coverage of injured workers generally based on their location of employment.
There are 11 main workers’ compensation schemes in Australia, one for each state and territory and 3 Commonwealth schemes.
Note – Independent contractors and sole traders are generally not covered by workers’ compensation schemes and must make their own income protection insurance arrangements.
Who can make a claim for Workers’ Compensation?
Any team member (employee) who suffers a work-related injury or illness is entitled to lodge a claim for workers’ compensation.
What is a work-related injury / illness?
A work-related injury / illness is one in which your employment is a ‘significant contributing factor’.
Sometimes employment is not the original cause of an injury / illness; however, employment can aggravate or accelerate an existing injury. Aggrevation may be covered provided your employment is a ‘significant contributing factor’.
Your claim for workers’ compensation WILL NOT be accepted if the injury / illness is:
- Due to drink or drug driving
- Caused by voluntary consumption of alcohol or drugs of addiction
- Self inflicted
- Due to willful misconduct
- A heart attack
Your claim for workers’ compensation MAY NOT be accepted if the injury / illness:
- Is an aggravation of a pre-existing injury / illness in which you have not disclosed to us (employer)
- Is a result of a failure to use personal protective equipment (PPE) provided
What happens if I get injured away from the workplace?
Depending on the state of jurisdiction:
- You may be able to lodge a workers’ compensation claim for an injury / illness that is sustained during a journey to or from work. Journey claims are not covered in all jusrisdctions. For more information, refer to page 77 of this Safe Work Australia Report.
- You can lodge a workers’ compensation claim for an injury / illness that is sustained during a break (but there are some exceptions).
- You may be able to lodge a workers’ compensation claim for an injury / illness that is sustained whilst on deployment, provided the injury / illness occurs whilst doing an activity that would be considered part of a normal routine, such as:
- A slip / trip at your accomodation
- A muscle sprain / strain during an evening walk / run.
Examples of injuries / illnesses sustained during deployment that would NOT be compensatable are those that arise from:
-
- Participation in an extreme sport
- Drink or drug driving
- Voluntary consumption of alcohol or drugs of addiction
- Willful misconduct
What can I claim?
If a claim for a work-related injury / illness is approved by the insurer:
- You can claim medical expenses, such as medication, medical aids and specialist appointments.
- If you are deemed as unfit for work, you can also claim some wages for time off work (lost time) – each State/Territory has different methods for calculating payments.
How do I make a claim?
If you wish to lodge a workers’ compensation claim for lost wages and / or medical expenses you will need to:
- Notify your manager of the injury / illness*
- Enter the injury / illness in RiskMan*
- Visit your GP and request a Workers Compensation Certificate of Capacity (CoC).
- Contact the Aspen Medical HSE Manager, who Is Aspen Medical’s Rehabiltation and Return to Work Coordinator (RRTWC).
The HSE Manager will provide you with a copy of the relevant claim form (each State/Territory has its own). Once completed and returned to the HSE Manager, this form will be submitted on your behalf. The relevant insurer will then process your claim and issue a determination to either accept or reject liability.
*If you are not comfortable discussing your injury / illness with your manager, reach out directly to the HSE Manager or a member of the C&P team. Incidents can be lodged in RiskMan confidentially.
What if I’m deemed unfit to work?
If your workers’ compensation CoC states that you are unfit to work, the HSE Manager and / or Insurance Claims Manager will be in regular contact with you whilst you are off work. You will need to attend regular RTW meetings. These meetings are to monitor your recovery and keep conversations open with yourself, your manager, the HSE Manager and the Insurance Claims Manager regarding your recovery and return-to-work options for when you are cleared to resume pre-injury duties. Whilst off work, you need to ensure your CoC is kept current.
CoCs need to be forwarded to:
- your Manager
- the HSE Manager
- Payroll
- your Insurance Claim Manager.
If you’re working reduced hours, you may need to complete a timesheet identifying the hours you worked and claim the rest as workers’ compensation leave – the HSE Manager will discuss this with you.
Return to Work (RTW) Plans
If you are fit to work, but with restrictions, the HSE Manager and / or the Insurance Claims Manager will develop a RTW Plan for you. This RTW Plan will stipulate what activities you can and can not do, based on your CoC. The aim of a RTW Plan is for you to gradually return to pre-injury duties. RTW Plans are an important part of your rehabilitation.
What if I’m not happy with the decision regarding my claim?
If you are not happy with the decision, once the insurer has issued a determination regarding liability, you have the right to request a reconsideration. You can discuss your options with the HSE Manager.
More Information
One of our workers compensation insurance providers is Allianz. They have some nice short videos cvering every step of the workers compensation claim journey, from being injured to returning to work.
Check them out here
