If I think I contracted COVID-19 at work, can I claim workers compensation?
In some circumstances coronavirus (COVID-19) may be a compensable workplace injury as a disease is included in the definition of injury under the Workers Compensation Act. To be compensable, you must have contracted the virus in the course of your employment and your work activities must be proven to be the main contributing factor to contracting the virus. Due to the nature of viruses, identifying how and when you contracted the virus can be difficult. Each claim will be assessed on its individual merits.
On 14 May 2020, the NSW Parliament passed an amendment to the Workers Compensation Act making it easier for certain types of employment to establish the link between work and contracting COVID-19. A new section in the Act states that workers with COVID-19 who work in certain types of employment will be presumed to have contracted the virus at work or while working.
This applies to the following areas of employment:
- the retail industry (excluding purely online businesses)
- the health care sector, including public health employees
- police and emergency services
- firefighters (including rural fire services)
- ambulance officers
- educational institutions, including pre-schools, schools and tertiary institutions (other than establishments providing only online teaching)
- the cleaning industry
- the construction industry
- restaurants, clubs and hotels
- disability and aged care facilities
- refuges, halfway houses and shelters
- passenger transport services
- courts and tribunals
- correctional and detention centres
- places of public entertainment or instruction (including cinemas, museums, galleries, cultural institutions, libraries and casinos)
- funeral homes
- childcare facilities.
The new Section in the Act also allows for other types of employment to be prescribed by Regulations, and these Regulations will be developed by the State Insurance Regulatory Authority (SIRA).
These new provisions apply to casual workers in the above areas of employment if they have worked on one or more of the 21 days before their date of injury. They also apply to workers who contracted COVID-19 before 14 May 2020 when the amendments were passed and the Regulations to be developed by SIRA will provide more guidance as to when and how this will be implemented.
Note that these new provisions do not apply if there is evidence that proves a worker in the above areas of employment contracted the COVID-19 virus outside of work. As such when lodging a claim, employers and workers are still required to provide information on the link between work and contracting the virus.
Therefore, when lodging a claim for alleged work related COVID-19, evidence continues to be required to confirm both the diagnosis and how the diagnosis is related to work. This includes a Certificate of Capacity from your doctor to confirm your diagnosis and information from you, your employer and nominated treating doctor to show when COVID-19 was contracted and how employment was the main contributing factor to contracting the virus.
If you want to lodge a claim for contracting COVID-19 at work, please follow the usual claim lodgement process.
You are encouraged to speak to your employer as quickly as possible if you believe you have contracted COVID-19 at work.
If my claim for COVID-19 is accepted, what am I covered for?
Normal entitlements apply as specified under the legislation. There are no special entitlements at present in relation to COVID-19 claims. Medical expenses and weekly payments for time loss may be paid as part of a workers compensation claim.
For further information on what types of support is available, please refer to the types of payments page.
If I can’t obtain a Certificate of Capacity because of COVID-19, what will happen to my weekly payments?
Injured workers are required to produce Certificates of Capacity for any period in which they are entitled to weekly payments. This is part of the legislation under which icare operates. During a pandemic situation, it may be difficult to see a doctor on a specific day. However, the legislation contains special provisions that may assist you and ensure you continue to receive weekly payments.
Certificates can be issued for more than 28 days in special circumstances. This may be appropriate when your injury is stable and your capacity is unlikely to change over the period of the certificate. SIRA has made changes to fees orders to allow telehealth (telephone) consultations with your doctor and allied health professionals to improve access if you cannot be at the doctors in person. Telehealth consultations need to be approved in advance by the claims service provider as well as you and your medical practitioner.
Can my claims service provider assist by paying for delivery of pharmaceutical items related to my injury?
Yes, the delivery of pharmaceutical items may be appropriate in some circumstances to ensure you have access to your medication and other items that specifically relate to your workers compensation injury.
Can my claims service provider assist by paying for food delivery or other services during the COVID-19 pandemic?
No, food delivery and other related services are not considered a claims cost and would need to be organised outside of the workers compensation claim. You should investigate delivery options available within the community such as priority delivery services for vulnerable members of the community if this is appropriate.
I don’t want to go to work because I am worried that I will catch COVID-19. How will this affect my weekly payments?
You should speak to your employer about any concerns you have about attending work in the first instance. They will be able to advise what plans are in place to reduce risk in your workplace or to advise of any special arrangements that are in place. Information on COVID-19 and work health and safety can be found on the SafeWork Australia website
The legislation requires injured workers to make reasonable efforts to return to work. If an claims service provider does not believe a worker is making reasonable efforts, it may take steps to suspend a worker’s weekly payments. What constitutes an unreasonable refusal to return to work will depend on the circumstances.
For any health advice, we recommend you check the NSW Health website
My employer has withdrawn my suitable duties because of COVID-19. Am I entitled to weekly benefits?
Some workers who return to work after an injury are placed on ‘suitable duties’ if they are unable to return to the job they had before their injury. Workers who have suitable duties removed by their employer as a result of the impact of COVID-19 may be entitled to weekly benefits. Weekly benefits will be paid in accordance with the legislation.
If a worker who has returned to work after an injury has full capacity for work (i.e. they are ‘fit for pre-injury duties’) then there is no ongoing entitlement to weekly benefits.
My employer encouraged or required me to have the COVID-19 vaccination for work and I have had an adverse reaction, can I claim workers compensation?
In some circumstances an adverse reaction to the COVID-19 vaccination may be covered under workers compensation. For it to be covered, a worker's employment must be a substantial or main contributing factor to the injury or illness.
When lodging a claim for an adverse reaction to the COVID-19 vaccination that is work related, medical information will need to be provided showing an injury or illness has been sustained
To be covered, the insurer will need to be satisfied that:
- the vaccine injury arose out of, or in the course of, the worker's employment; and
- the worker's employment was a substantial contributing factor to the vaccine injury or was the main contributing factor for a disease injury; or
- in the case of heart attack or stroke injury, the nature of the employment was a relevant factor in increasing the risk of the injury.
While each claim needs to be assessed on its own evidence, several factors may increase the likelihood that a vaccine injury is covered under workers compensation, including whether an employer:
- Took steps to arrange for its employees to be administered a COVID-19 vaccine.
- Had encouraged or induced its employees to get vaccinated in order to obtain benefits for its business.
- Permitted or directed employees to have a COVID-19 vaccination during ordinary working hours, or
- Had provided instructions to employees relating to the administration of the vaccine.
The link between the vaccine injury and the worker's employment is easier to establish where a worker is influenced by their employer's requirement to get vaccinated or is subject to a NSW Government Public Health Order. In these circumstances there is an increased likelihood of the vaccine injury being covered under workers compensation.
If you want to lodge a claim for a work-related adverse reaction to the COVID-19 vaccination, please follow the usual claim lodgement process.
Special conditions for first responders (exempt workers)
Police officers, fire fighters and paramedics are known as 'exempt workers'. For exempt workers, employment must have been a substantial contributing factor to the injury. An exempt worker will still need to prove that:
- an injury was sustained in the course of employment
- there was a causal link between the COVID-19 vaccine and the adverse reaction.
Can I ask for confirmation that an Independent Medical Examiner, Factual Examiner, or Rehabilitation Provider has been vaccinated before attending an appointment?
At this stage, there is no requirement for businesses to disclose whether their staff members have received the COVID-19 vaccine to visitors to the business.
You may ask a service provider whether their staff have been vaccinated, however, a provider is unlikely to provide this information due to privacy obligations they have towards their staff members. With consent from their employees a service provider may give you this information.
Your case manager will take your preferences into account when making appointments with service providers. Appropriate social distancing measures (where possible) should still be in place and followed when attending an appointment.
If I am injured while working from home, will I be covered by workers compensation?
Yes, you may be covered. If you are encouraged or directed to work remotely or at home and can show your work played a substantial contributing factor to an injury, then your injury may be covered by workers compensation. Each claim would, however, need to be assessed on its individual merits.
If I decide to work at an alternate address such as a friend or colleague’s house, will I still be covered by workers compensation if I get injured?
Yes, you may be covered as the same principles apply as if you were working from home. In order for the claim to be accepted there must be evidence that you sustained your injury arising out of, or in the course of your work, and that your employment was a substantial contributing factor to the injury. Each claim would need to be assessed on its individual merits.
If I come into contact with a person with COVID-19 whilst working from home, can I make a claim under workers compensation?
Contracting COVID-19 can constitute an injury under workers compensation because a disease is included in the definition of injury under the Workers Compensation Act. However, work must be proven to be the main contributing factor to contracting the virus.
I'm on a Return to Work plan and have been asked to work at home. How can my employer help to ensure my injury is properly accommodated in my home?
In these circumstances it may be appropriate for the employer to organise a workplace assessment of the home work environment. There are aides and equipment that the employer can also request to ensure that your injury is accommodated in the home environment.
I don’t want to go to the doctor/treatment provider because I’m worried I will catch COVID-19. How will this affect my weekly payments?
The legislation requires injured workers to attend medical appointments at certain periods of time. It could be to obtain a Certificate of Capacity (see above) or it could be a medical examination that has been requested for a particular reason.
Certificate of Capacity
If you do not obtain a Certificate of Capacity, you may not be entitled to weekly payments. The legislation does provide some flexibility to ensure you can still receive weekly payments in situations where you cannot see your doctor straight away or as regularly as you are used to. However, you must discuss this with your case manager first.
You may also obtain a Certificate of Capacity for a period greater than 28 days. This may be appropriate in circumstances where your injury is stable and your capacity for work is unlikely to change.
The legislation allows claims service provider to request an injured worker attend a medical examination. If an injured worker unreasonably refuses to attend this examination, their weekly payments may be suspended. What constitutes an unreasonable refusal will depend on the circumstances.
It is important that any Public Health (COVID-19 Mandatory Face Coverings) Orders are adhered to when attending a medical examination. For information on current Orders, and for any health advice, we recommend you check the NSW Health website.
Other treatment types
You can also attend medical appointments via telephone (telehealth) as well as consultations via video. Telehealth consultations require pre-approval from the insurer and must be consented to by all parties – the worker, practitioner and insurer. Note that if you refuse to participate in your treatment plan your benefits can be suspended.
Can I attend telehealth consultations with doctors instead of in person?
Yes. Changes have been announced which allow consultations to be held via telephone in addition to the already occurring video consultations.
Telehealth services with General Practitioners and medical specialists within three months of your date of injury do not need pre-approval from the claims service provider.
All other telehealth services require pre-approval, including those provided by SIRA-approved allied health providers.
However, telehealth consultations may not always be an appropriate replacement for face-to-face treatment. Independent Medical Examinations that require a physical assessment are unlikely to be able to proceed as a telehealth consultation. Note that if you refuse to participate in your treatment plan your benefits can be suspended.
Are allied health practitioners allowed to provide Certificates of Capacity?
Yes, amendments to the regulations have been made to allow SIRA-approved physiotherapists and psychologists to issue Certificates of Capacity. The initial Certificate of Capacity must still be issued by a medical practitioner (the Nominated Treating Doctor).
These changes are designed to relieve pressure on general practitioners and the overall health system during the COVID-19 pandemic; they are also time limited and will be in place for a further 12 months (from April 2021) unless repealed earlier.
SIRA has produced a Certificate of capacity/Certificate of fitness (PDF, 0.2 MB) for treating physiotherapists or psychologists and has released a training package for treating physiotherapists and psychologists on how to complete the Certificate.
What if I am stood down or have reduced shifts due to the business impacts of COVID-19, is this covered by workers compensation?
No, business disruption is not covered under workers compensation.
Is job seeking still required?
Under workers compensation legislation, workers are still expected to make reasonable efforts to return to work, and this includes job seeking. Many types of jobs have been impacted by COVID-19. You should discuss this situation with your Case Manager and Workplace Rehabilitation Provider to ensure that appropriate training and support is provided to job seek in the current labour market.
What if I need re-training but cannot attend sessions due to facilities being shut?
If there are no alternate or direct pathways back to work then the Case Manager and Workplace Rehabilitation Provider will need to explore all options for this training to be completed. This may include investigating options for SIRA funded programs for aides, equipment and training.
If you have any questions please speak with your Case Manager. Alternatively you can contact the icare Complaints Resolution Team on 13 99 22.
Further information and updates on COVID-19 can be found by visiting: