Who is eligible to make a workers insurance claim
If you've been injured at work, you may be eligible to make a claim for workers compensation, and get help with returning to work.
The workers insurance system is designed to help you get back to full participation in work and life, with a range of benefits to support your recovery at work.
The support we can provide and timeline of care will depend on your individual claim and the type, nature and severity of the workplace injury or illness.
Even if your employer doesn’t have workers insurance, you can still make a claim.
Who can make a claim
If you’re injured at work, notify your employer as soon as possible.
Your employer will contact the insurer to notify them of your injury and may start the claims process on your behalf. At this time, your employer should provide you with the insurer’s contact details.
You can also lodge a claim with the insurer if your employer hasn’t done so. If you need help lodging a claim, contact our customer support services on 13 44 22.
The insurer will contact you to discuss any payments you may be entitled to if you need time off work, are working reduced hours and/or are in need of medical services.
They will also contact your employer and, if necessary, your nominated treating doctor to determine how best to support your recovery.
Your nominated treating doctor provides a certificate of capacity that determines if you are able to work, what types of duties you may be able to perform and what kind of treatment you need.
If you can’t do your job, you should ask your doctor and employer about suitable alternative duties.
Types of claims we cover
A workplace injury or illness may be physical or psychological in nature.
There are different types of claims that have specific eligibility criteria:
- medical treatment and rehabilitation expenses
- weekly payments
- psychological injury
- permanent impairment
- work break and journey injuries
- hearing impairment.
When making a claim, medical evidence is required to indicate that you suffer from an injury or illness as a result of your employment.
Time limits for making a claim
Make a claim as soon as possible so the right support is provided for your recovery.
A claim can be made within six months of the date of injury or accident.
If your injury or illness arises after your employment has finished, you may still be covered under workers insurance. This is common with injuries that have a delayed onset, such as hearing impairment claims and permanent impairment. Your injury must still be related to your employment.
If you are unsure, get in touch to discuss your situation.
Returning to work
We understand that when you’re injured at work there are three things that matter: your health, your wellbeing and returning to work.
Our scheme is based on research and evidence about the health benefits of work and we know:
- The longer you are away from work, the likelihood of you ever returning to work declines
- Staying active after injury reduces pain symptoms and helps you return to your usual activities at home and at work sooner
- Working helps you stay active which is an important part of your treatment and rehabilitation.
Returning to work, where possible, or recovering at work after an injury, can help with healing and recovery. This can also reduce any disruptions to you, your family, your employer and co-workers.
Your employer is obligated by law to provide suitable work that matches your capacity and supports your recovery where possible. Your employer will talk to you, the insurer and your doctor to understand your needs.
If you work for a large employer, there may be a Return to Work Coordinator, whose role is to assist with your recovery at work.
Your employer can’t dismiss you because of your work-related injury within six months of when you first become unfit for work.
Your role is to focus on recovery and aim to stay at work in some capacity, or return to work as soon as possible.
You should develop and maintain clear communication with both your employer and the insurer, and understand the role of each person to get the right help at the right time.
There are services available to help you take an active role in your recovery at work and assist you as your capacity for work increases.
Your case management specialist
If you require time off work, a case management specialist may be assigned to you to coordinate all aspects of your claim. This will depend on the severity of your injury and the services required.
Their role is to act as your central point of contact, maintain open communication with your employer and treating practitioner, and ensure you receive the right help at the right time.
The workplace rehabilitation provider
An approved workplace rehabilitation provider may be appointed to your claim depending on the severity of the injury and the services required.
They are highly-experienced experts who can address the physical, functional, psychological and/or workplace barriers that may affect you recovering at work or returning to work.
Your doctor will assess, diagnose, and treat you like any other patient. The doctor will also assess your capacity and support your recovery at work.
Who is involved in your claim
Severe workplace injuries
If you have sustained a severe injury in a NSW workplace and have an accepted workers insurance claim, you may be eligible for the Workers Care Program.
Severe injuries can include:
- brain injury
- spinal cord injury
- permanent blindness.