Workers' Compensation FAQ's

1. The injured employee completes the Workers’ Compensation Claim Form 2B and submits this to the employer along with the First Medical Certificate provided by the treating doctor.
2. The employer completes the Employer’s Report Form and the employer details on the Workers’ Compensation Claim Form 2B. RiskCover require the employer to then submit these forms, along with medical certificates, accounts and witness statements (if applicable) within 3 days of receipt of the claim from the employee.

Post
RiskCover
GPO Box K837
Perth WA 6842

Online
RiskCover has a secure websit for your agency to submit your claims online. If you do not have access to lodge claims, please contact your RiskCover Fund Services Coordinator/Officer.

An employee should ensure that the completed claim is submitted to his/her employer as soon as possible. RiskCover require the employer to submit a claim within 3 days of receiving a completed claim form from the employee. This is essential to ensure that RiskCover can promptly process and make a decision on the claim within the 17-day legislated time frame which commences on the day the employee lodges the claim with his/her employer.

On receipt of a claim from an agency, RiskCover will assess and make a decision on liability in accordance with the Workers' Compensation and Injury Management Act 1981 and notify the employee and employer.

Please see RiskCover's Product Disclosure Statement for more information on Workers' Compensation cover.

If a decision on liability is unable to be made within 17 days of a claim being lodged with the employer, RiskCover will provide written reasons as to why liability is pended, stating the nature and substance of the further information that is required.

Some common reasons for liability being pended include:

• further medical information required
• employee's medical authority/ consent to obtain information required
• further particulars of the injury circumstances required

RiskCover must provide a decision (accept/pend/decline) on a submitted claim within 17 days of lodgement with the employer of the Workers’ Compensation Claim Form 2B and First Medical Certificate.

A letter will be forwarded within the prescribed time frame advising on the liability decision. If the decision is to pend or decline liability, RiskCover will provide a reason for that decision.

Providing an employee is carrying out authorised duties for their employer at a location other than their usual workplace, they would be covered for Workers’ Compensation. This includes attendance at seminars and training programs.

In some circumstances, employees will also be covered for injuries sustained while travelling to and from these alternative locations as long as there are no substantial deviations or interuptions in the journey.

Generally employees are not covered for travelling to and from work, however, under certain circumstances employees may be entitled to workers’ compensation.

For further information, an employee should speak to a line manager/supervisor and agencies should contact their RiskCover Injury Services Coordinator/Officer.

Injury management involves the injured employee, the treating medical practitioner and the employer working together to assist the employee to remain at or return to work. The Workers’ Compensation and Injury Management Act 1981 places an obligation on all parties to actively participate in injury management.

More information is available in our Injury Management FAQ's and Workers' Compensation Code of Practice (Injury Management) 2005.

The Workers’ Compensation and Injury Management Act 1981 states that the following treatments, where necessary and reasonable, will be paid in accordance with WorkCover’s Gazetted fees where applicable:

• General Practitioners (GPs),
• Medical Specialists,
• Physiotherapists,
• Chiropractors,
• Ambulance,
• Chemist expenses,
• Psychological,
• Dental,
• Hydrotherapy,
• Occupational Therapists,
• Osteopaths.

Consideration will be given for other types of treatments but will usually require a referral from a GP/specialist.

Workplace rehabilitation is specific services that may assist employees to remain in or return to suitable work.

When the employee, employer and treating medical practitioner agree that workplace rehabilitation is required, the employee has a right to choose the provider. For a list of WorkCover Approved workplace Rehabilitation Providers see the WorkCover WA website..

Some of the services Approved Workplace Rehabilitation Providers offer include:

• Case management
• Worksite assessment
• Vocational assessment and job placement
• Functional capacity evaluation

If the services of an Approved Workplace Rehabilitation Provider are required the employee has the right to choose the provider. For a list of Approved Workplace Rehabilitation Providers, please see the WorkCover website.

Most fees payable in relation to services provided under workers’ compensation are prescribed by WorkCover (see WorkCover’s Gazetted fees). If there is a difference between the fee charged and the amount prescribed by WorkCover, an employee may be asked to bear the cost.

Employee's are entitled to claim reasonable costs associated with travelling to and from appointments. To do this RiskCover requires evidence of the travel being claimed to consider reimbursement of these costs. For example, a statement indicating appointment attended and kilometres travelled.

From 1 July 2011 the rate payable is 42c per km. This rate is indexed annually (each July).

In circumstances where an employee's injury prevents use of a personal motor vehicle or public transport, please contact RiskCover to discuss alternative arrangements.

Prescribed amounts are the maximum entitlements available to an injured employee for such things as weekly payments, medical expenses and vocational rehabilitation.

The current prescribed amounts are available on the WorkCover website.

A second schedule entitlement may be available to employees whose injuries have stabilised and resulted in permanent impairment. Permanent impairment is assessed in percentage terms by a GP or Specialist, and relates to a specific part of the body. Each percentage impairment is assigned a monetary value in accordance with second schedule of the Workers’ Compensation and Injury Management Act 1981.

Injury arising after 14th November 2005 must be assesed by a GP or specialist approved by WorkCover.

Yes, however to ensure success of a return to work program it may be preferable that employees refrain from taking annual leave or long service leave while on a return to work program. This should be discussed by the employee and with his/her line manager/supervisor.

When an injured employee disagrees with a claims decision made by RiskCover access to a three stage dispute resolution process is available.

The three stages of dispute resolution are:

Stage 1
The employee should discuss the concerns or issues with his/her employer who may be able to resolve the matter immediately or take up the matter with RiskCover on the employee’s behalf.

Stage 2
The employee should contact the RiskCover Injury Services Coordinator/Officer assigned to the claim. This will provide the employee with access to RiskCover’s Internal Dispute Resolution process. Either the Injury Services Coordinator/Officer will be able to resolve the issue for the employee directly or will refer the matter to a senior RiskCover Officer for review and resolution.

RiskCover will respond to any dispute created either at the time of the initial contact with the party concerned, or within 3 working days of the lodgement of the dispute.

If the matter cannot be resolved by the initial informal discussion, and further information (eg. new medical or factual evidence) that may allow a decision to be reconsidered is subsequently provided, RiskCover will review the further submission within 10 days of receipt and notify the party whether or not the dispute can be resolved.

Stage 3
An employee may refer the matter to the WorkCover WA Conciliation and Arbitration Services (CAS) for determination where:

• the party is not prepared or able to provide additional information for reconsideration;
• the further information submitted has been reviewed; however, subsequent discussion has failed to resolve the dispute.

Where an injured employee is legally represented, RiskCover will provide the representative with copies of any correspondence that is sent to the employee.

RiskCover recommends that an employee follows this process through the stages, however the employee has the right to move directly to stage 2 or 3 if they wish.

The Conciliation and Arbitration Services (CAS) is a division of WorkCover WA with the responsibility of arbitrating disputes between parties within the workers' compensation system.

If an employee, with an accepted claim, experiences a return of symptoms that causes incapacity and/or requires additional treatment after a period of recovery from the original injury, the employee is required to:

• Report the recurrence immediately to the employer.
• Provide a current Medical Certificate from a General Practitioner.
• Complete a RiskCover Recurrence of Disability Form and submit the form to his/her employer.

The employer must then submit the completed form and medical certificate to RiskCover within three days.

RiskCover will review the claim and information provided to determine and communicate a decision on liability.

For more information an agency should contact their Injury Services Coordinator/Officer at RiskCover. Employees in the first instance should seek advice from their employer. If a claim has been lodged, a RiskCover contact will be identified on correspondence. If you require information in relation to a Fund Management or Cover enquiry, refer to the Fund Management section or Product Disclosure Section of this website.