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This is a WorkCover Prescribed Form to be completed by the employee when they wish to lodge a claim for a work injury.
The employer must ensure that the employee completes all relevant sections of the form, including the Worker's Consent Authority which allows RiskCover to seek relevant medical information.
The employer should ensure the Employer Details section is completed and date stamped on the date the claim form was lodged by the employee.
RiskCover requires the employer to complete this form when an employee lodges a claim for a work injury to assist in progressing the claim. An agency must forward the following documentation to RiskCover within three days of the employer receiving the Workers’ Compensation Claim Form 2B and first medical certificate from the employee:
Any other information the employer feels may assist RiskCover can accompany the Employer’s Report Form when submitted.
The employer can complete this form and attach when submitting a claim to RiskCover.
It highlights important information such as:
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 must complete a Recurrence of Injury Form.
This form must be lodged with the employer, together with a progress medical certificate from the treating doctor supporting the change in medical status. The employer must date stamp this form and submit it to RiskCover within three days of lodgement by the employee.
If a claim is lodged for a work injury, the employer should identify if there are any witnesses to the incident and if so, arrange for each witness to complete this form.
An “eye witness” is someone who physically witnessed the actual incident, whereas a “workmate having knowledge” is someone who did not actually see the incident but is a person to whom the employee first reported the incident and/or complained of any symptoms that he/she experienced.
Where an employee has an injury whilst either driving a motor vehicle or engaged in travel for authorised work purposes, the employee must complete this form in addition to the Workers’ Compensation Claim Form 2B.
If an injured employee in receipt of weekly compensation payments commences in some other work with another employer (including becoming self-employed), then under the Workers’ Compensation and Injury Management Act 1981, they must then declare the details of that employment to their employer and RiskCover by completing this form within 7 days of commencing that work. Depending on the employee’s earnings from this employment, it may affect their weekly compensation rate.
This form is to be used by employers submitting invoices by mail for reimbursement of weekly payments made to injured employees.
The invoice should specify:
If the employee has returned to work this should be clearly indicated on the invoice.
These invoices should be submitted to RiskCover in a timely manner to ensure prompt reimbursement.
If an injured employee incurs out-of-pocket expenses as a result of travelling to and from medical or allied medical treatment, he/she is entitled to claim reimbursement of those expenses at the rate prescribed by WorkCover. This is currently $0.40 per kilometre travelled.
The employee is required to complete this form specifying:
A medical certificate from the treating doctor confirming the treatment is necessary is also required. If the employee has incurred expenses such as taxi fares, then receipts must also be attached.
This form can be submitted to RiskCover by the employee or by the employer on their behalf.
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