WorkCover Victoria: How To Make a WorkCover Claim

When you are injured at your workplace in Victoria, WorkCover is your best resource for covering your medical expenses, loss of income, and other expenses.

This article will answer your most frequently asked questions about workers compensation legislation, processes, and guidelines in Victoria. By the end, you’ll have become an expert in the following key topics:

• How WorkCover works and what it covers
• Who can make a WorkCover claim
• How to lodge a WorkCover claim
• How WorkCover payouts are calculated
• How long WorkCover benefits last

What is WorkCover in Victoria?

WorkCover is a type of workers compensation insurance provided by WorkSafe Victoria, a statutory authority that regulates workplace health and safety in the state.

Workers compensation insurance is an important resource for workers, especially considering the Workers compensation Victoria statistics:

• The total number of standard workers compensation claims per 100 FTE (full time employee) increased from 773 in 2020-21 to 928 in 2021-22.
• The rate of claims per 100 FTE increased from 1.06 in 2020-21 to 1.25 in 2021-22.

As the need for workers compensation rises, workers in Victoria should have access to as much information as possible about how WorkCover works and how they can make a claim, if needed.

Is WorkCover in Victoria a no-fault scheme?

WorkCover in Victoria is a no-fault scheme. This means that the statutory scheme insurance will cover you for certain no fault benefits such as weekly payments of compensation, medical and like expenses and whole person impairment lump sum compensation, regardless of whether or not the injury was your fault.

Workers compensation legislation for Victoria

Historically, workers compensation legislation in Victoria consisted of three Acts:

• The Accident Compensation Act 1985
• The Workplace Injury Rehabilitation and Compensation Act 2013

The latter legislative measure – AKA the WIRC Act 2013 – replaced the Accident Compensation Act 1985. Substantively, many of the provisions remain the same for injured workers. The WIRC Act 2013 applies to workers who sustained their injuries on or after 1 July 2014. For injuries sustained prior to that date, the Accident Compensation Act 1985 still applies. Today, it regulates how workers compensation functions and the processes for filing and fulfilling claims.

How does WorkCover insurance work in Victoria? 

WorkCover insurance in Victoria is a workers compensation insurance for employers to help them cover certain costs if one of their employees sustains an injury arising out of or in the course of employment. It’s beneficial for workers, as they may be entitled to weekly payments of compensation to cover loss of income if unable to work due to their injuries, as well as the medical and like expenses associated with their injuries.

Who can make a workers compensation claim in Victoria? 

To make a workers compensation claim, you must 

a) be a worker in Victoria and 

b) have sustained a physical or mental injury at your place of work

You are a worker for the purposes of the legislation if you:

• Are working casual, part time, or full time for a company in Victoria
• Are an apprentice, volunteer, or interstate/overseas worker

If you are an independent contractor, you may also be  a deemed worker for the purposes of the workcover legislation if you perform at least 80% of your work for the one entity.

What does workers compensation cover in Victoria?

The main costs that Workers Compensation cover include the following:

• Lost income due to an inability to work
• Medical treatment and rehabilitation expenses
• Lump sum compensation to pay for serious injuries

How do you make a WorkCover claim in Victoria?

The steps for making a WorkCover claim in Victoria are as follows.

Step 1: The worker must fill out a worker’s injury claim form, and lodge the completed form with their employer.

Step 2: The employer must submit the claim form to their WorkSafe agent.

Step 3: The WorkSafe agent has 28 days to assess the claim and decide whether liability is accepted or rejected.  

Step 4: As part of the process to determine liability, the agent will usually:

(a) arrange for a Circumstance Investigation Report to be prepared. This will involve an investigator taking statements from the injured worker, and from any potential witnesses at the employer. The goal of the circumstance investigation report is to uncover all the facts, so that the agent is fully informed as to the circumstances of the injury, and to assist them to make the right decision regarding liability on the claim.

(b) Schedule an Independent Medical Examination (‘IME’) for the worker to attend. The purpose of the IME is for the agent to obtain an independent medical assessment in relation to the claimed injuries.

Step 5: On completion of their investigations, the agent will write to the worker advising of the liability decision. If liability is accepted, then weekly payments and payment of medical and like expenses will commence. If liability is rejected the worker has the right to dispute that decision by way of referring the matter to conciliation at the Workplace Injury Commission.

How long does workers compensation last in Victoria?

An injured worker is entitled to weekly payments of compensation for a period of 130 weeks if they are not fit to perform their pre-injury work by reason of their injuries. Weekly payments can continue beyond 130 weeks if a worker continues to be certified as totally unfit for all forms of suitable employment for the foreseeable future, and not just their pre-injury employment.

Is superannuation payable on WorkCover payments in Victoria?

Providing they meet certain requirements, workers are eligible to receive superannuation on their WorkCover payments in Victoria. Those requirements are:

• Worker was injured on or after April 5th, 2010
• Worker has received weekly payments for an aggregate period of 52 weeks
• Worker will be receiving weekly payments
• Worker is younger than retirement age
• Worker is not receiving superannuation from their employer under a public sector superannuation scheme, law, or industrial award (e.g., make up pay).

The rules with working and workers compensation claims

 In this section, we’ll cover the most important rules that employers and workers in Victoria should follow regarding working and workers compensation claims.

Can you terminate an employee on WorkCover in Victoria? 

An injured worker’s position of employment must be maintained for the first 52 weeks after the date of injury.  At the 52 week mark, the employer does have rights to terminate the employment of a worker that is not fit to perform the inherent duties of their employment on an unrestricted, full time basis. However, the termination of an injured worker’s employment on these grounds does not mean that their WorkCover payments will cease. Weekly payments of compensation will continue in accordance with the legislation, unaffected, in these circumstances.

Can I resign while on WorkCover in Victoria? 

Employees on WorkCover can resign from their job and continue to receive WorkCover payments.

Guide to WorkCover Payouts in Victoria 

One of the topics regarding workers compensation in Victoria that workers want to know the most about is how they will receive their WorkCover payout. How are their payouts calculated? And how much will WorkCover pay? These are the questions that this section will answer.

How is WorkCover calculated?

The agent will calculate a pre-injury average weekly earnings (‘PIAWE’) figure. This is  typically calculated based on the worker’s average earnings over the past 52 weeks of employment. It should be noted that this calculation can take into account concurrent work with a different employer that the worker is now also prevented from performing due to their injuries.

If a worker has not been employed with the same company for 52 weeks, their WorkCover payments are based on the average PIAWE of the amount of time they have worked there.

Any overtime, allowances, bonuses and commissions received by the worker are included in the calculation of the PIAWE for the first 12 months of entitlement to weekly payments. At the 12 month mark, the PIAWE is recalculated without those payments included.

How much does WorkCover pay?

A worker is paid at the rate of 95% of the PIAWE for the first 13 weeks of entitlement, and at the rate of 80% of the PIAWE for the remainder of their period of entitlement. The base PIAWE figure is indexed on the anniversary of the claim each year after the date of injury.

The Workers comp payout guide below summarises the weekly entitlement that workers can expect to receive based on three different periods: 0-13 weeks, 14-130 weeks, and beyond 130 weeks up to retirement age.

The statutory maximum of $2660 in the table above is equal to twice the average weekly earnings figure in Victoria in 2023/24. This figure is indexed annually.

You may also be entitled to a partial weekly payment from the agent if you have a partial work capacity only by reason of your injuries.

Lump sum compensation claims

Depending on the severity of the injuries, a worker may also have entitlements to lump sum compensation under Workcover legislation. There are two lump sum claims that may be available to an injured worker in Victoria:

1. Impairment benefit claim – this is a no fault claim, similar to the claim for weekly payments and medical expenses. If the claimed injuries are assessed as reaching the required threshold of whole person impairment, then a worker will receive lump sum compensation for those injuries.
2. Common law damages claim – if an injured worker’s injuries satisfy the threshold to be awarded a serious injury certificate, and liability can be established against the employer (or in some cases another party), then a worker can receive common law damages. There are two separate heads of damages, pain and suffering and loss of earnings, that a worker can potentially access as part of a common law damages claim.

Example of a successful Victoria workers compensation settlement 

Our client sustained lower back injuries when they were required to bend over in a tight and confined space in order to decommission a chilled water plant room at work. They underwent surgery and injections, but they continued to suffer ongoing lower back pain and a restricted range of movement. They were unable to return to work as a refrigeration mechanic; however, they were eventually able to return to predominantly office work. LHD Lawyers negotiated a $165,000.00 settlement for our client after the claim was rejected by the Defendant, then ultimately fought and won at court. 

For more case studies, visit our workers compensation payout hub.

Make a Workers Compensation Claim Today

If you think you have a workers compensation claim to make in Victoria, LHD Lawyers can help everyday Australians receive the benefits they’re entitled to. We are so sure of our abilities to win your case that we stand firmly by our No Win No Fee Policy: if we don’t win, you don’t pay. Call 1800 455 725 for a no-obligation consultation about your case.

Author: Steve Notarianni