How to make a workers' compensation claim

What is a work-related injury?

A work-related injury is an injury that happened at or because of work. Types of work-related injuries may include:

• musculoskeletal disorders
• wounds and cuts
• burns
• fractures
• illnesses, and
• psychological injuries.

When can a workers’ compensation claim be made?

A workers’ compensation claim may be able to be made if a worker:

• has an accident at work
• contracts a disease from work
• further damages a previous injury at work
• is injured travelling to or from the workplace
• is injured travelling to or from an educational institute for work-related purposes.
• is injured travelling between their home or workplace, to get a medical certificate, medical advice, treatment, or compensation in relation to a previous injury for which the worker is entitled to compensation.

Making a claim

If a worker has been injured at work or while travelling on a work-related matter.

Step 1 – A worker must notify their employer of the injury as soon as possible. Please note:

• The employer does not investigate the claim - the insurer will investigate it.
• The employer must continue paying the worker until advised by the insurer.
• The employer cannot use the injured worker’s personal or annual leave in place of workers’ compensation.
• The employer will seek reimbursement of wages from the insurer.

Step 2 - The employer must notify their insurer within 48 hours of receiving notification and enter the details of the injury in the Register of Injuries for the workplace.

If a worker is incapacitated for work for 7 days or more.

Step 3 – The worker must complete and give the claim form and Certificate of Capacity to the employer/insurer within 7 days or the employer will stop payment of the worker’s wages.

• the insurer must contact the worker, the employer and, if appropriate, the worker’s nominated treating doctor, within 3 business days.
• claim forms are available from the employer.
• a Certificate of Capacity form is available from a worker’s nominated treating doctor.
• complete the claim form, attach the certificate, and give it to the employer.
• the employer must send the claim form to their insurer within 7 days of receiving the claim from the injured worker.
• the insurer will accept or reject the claim within 28 days.

If an injury is significant.

Step 4 – The insurer must establish a personal injury plan in consultation with the employer and injured worker and must comply with reasonable duties under this plan.

• the personal injury plan can be developed with the help of an approved workplace rehabilitation provider.
• the insurer must appoint an approved rehabilitation provider for the worker as part of the personal injury plan if the worker has not returned to normal expected duties and working hours (pre-injury) within 4 weeks after the day the employer was notified of the injury.
• the employer must provide suitable duties for an injured worker if requested and where available, for 6 months post the date of injury.

Responsibilities of an injured worker

Injured workers must inform their employer as soon as possible after they sustain a workplace injury unless it is impractical for them to do so.

Injured workers must take all reasonable steps to return to the workplace as soon possible and participate and cooperate in a Personal Injury Plan agreed to by an employer and the worker. A personal injury plan is a plan for coordinating and managing the aspects of injury management that relate to medical treatment and rehabilitation services for the worker to achieve a timely, safe and durable return to work.

Under legislation, injured workers:

• can choose their doctor to assist in coordinating their personal injury plan and return to work.
• are consulted in the stages of a personal injury plan created by the insurer and the employer with the help of an approved rehabilitation provider and the nominated treating doctor.
• must comply with reasonable obligations as set out and agreed in the personal injury plan.

If the employer does not have workers’ compensation insurance

The ACT Default Insurance Fund (DIF) provides a safety net to injured workers who are left without access to workers’ compensation due to the actions of their employer. Head to the DIF page on the ACT Treasury website for more.