How Worker’s Compensation Works

Get in touch: 1800 770 780

How can we help?

In Australia, if you sustain an injury or illness while in the course of your employment, you will be entitled to compensation. This compensation usually takes the form of replacement of lost wages and medical expenses. However, there are certain elements that must be met by both the employer and the employee for a workers’ compensation claim to be successfully filed and the injured worker compensated.

If you’re wondering, “how does workers compensation work?” keep reading or speak to one of our experienced workers compensation lawyers today.


Types of Compensable Injuries

The first thing you need to know about how workers compensation works is that your injury must have occured in the workplace during work hours in order for it to be compensable. This includes if you leave your place of employment to complete work-related tasks elsewhere. In addition, the injury you suffer does not have to be from a traumatic type of injury, but can be an injury that has occurred over time due to repetitive physical activity. It can also include an exacerbation of a pre-existing condition.

Accidental Injuries

An accidental injury is one that meets the following criteria:

  1. It occurs in the workplace and/or during work hours resulting from a single incident that causes injury to the employee.
  2. It requires medical treatment.
  3. It may or may not cause lost time from work.

Find out more: Head Injury Compensation Claims  | Eye Injury Compensation Claims

Repetitive Stress Injuries/Occupational Diseases

A repetitive stress injury is one that meets the following criteria:

  1. It occurs as the result of doing the same or similar physical activity on a regular basis.
  2. It required medical attention.
  3. It may or may not cause lost time from work.
  4. It may or may not require an orthotic modification for the work to continue to be completed in a physically healthy manner.

Find out more: RSI Compensation Claims

NB: There are also some occupational diseases that occur as a result of repetitive exposure in a work environment, for example lung and dust diseases. Speak to one of our specialist asbestos injury lawyers in this regard.

Exacerbation of a Pre-Existing Condition

The workers compensation system also allows for an exacerbation of a pre-existing condition to be a work-related injury if the following criteria are met:

  1.  The exacerbation occurs as a result of a work-related accident or occupational disease.
  2. Medical evidence supports that the condition was dormant prior to the work-related incident.
  3. It may or may not cause lost time from work.
  4. It may or may not require medical attention.

Find out more: Stress-Related Workers’ Compensation

How Does Workers Compensation Work? Filing A Claim

If you are injured at work, there are very specific steps you and your employer must take as part of the claims process. As an employee you must do the following.

Injured Employee Must:

  • Report the injury or occupational disease or exacerbation of a pre-existing condition to their employer.
  • The injury must be reported in a timely manner.
  • A written statement as to how the injury occurred should be given to the employer.
  • Medical attention should be sought as soon as possible.
  • Any medical services rendered should be reported to the employer contemporaneously with receiving them.
  • Complete all of the necessary paperwork supplied by the employer.

Employer Must:

  • Make a written report of the injury.
  • Provide the employee with all of the necessary paperwork to file a claim.
  • Inform the insurance carrier of the accident.
  • Allow the employee to seek medical attention as soon as possible.

Receiving Workers’ Compensation Benefits

There is a critical point to make when answering the question, how does workers compensation work? Before you can receive workers’ compensation benefits, all of the above steps must be completed AND the workers’ compensation insurance carrier for the employer must accept your claim.

If your claim is accepted, benefits can begin promptly. However, if the insurance company and/or the employer denies your injury/repetitive stress/exacerbation occurred at work, you will most likely be required to show proof to support your claim. In this instance, it is highly recommended you seek legal advice immediately. A solicitor who specialises in common law claims will be able to help you successfully navigate the process.

If benefits are awarded, they can include the following;

  • Lost wages paid to you for being unable to perform your job
  • Medical expenses covered including; hospitalisation, doctor visits, testing, surgeries
  • Prescription Medications
  • Rehabilitation Services
  • Orthotics

How Does Workers Compensation Work? Claim Settlement

Workers’ compensation claims are settled in a couple of different ways. First, if you recover from your injury and return to work with no permanent impairment, your benefits will cease and your employer will resume paying you your wages.

Second, if your condition leaves you with some form of ongoing permanent condition, you will enter into a settlement to compensate you for your physical loss and possible ongoing medical needs.

9-step claim settlement process

The process of a settlement includes the following steps:

  1. The claim is reviewed by the insurance company and your current condition is assessed.
  2. Your condition is found to have some aspect of permanent injury.
  3. A value is placed on the extent of the injury.
  4. An assessment of the ongoing medical costs is completed.
  5. The insurer will make a settlement offer.
  6. Negotiations will ensue between yourself and your solicitor and the insurance carrier until an agreement is reached.
  7. The agreement is written and signed by all parties.
  8. The written agreement is forwarded to WorkCover for approval.
  9. Upon approval the settlement is disbursed to the injured worker.

While a workers’ compensation claim can move smoothly through the process, it is likely that there will be legal obstacles along the way. Therefore, it is highly recommended that upon being injured at work you seek the advice of a solicitor that specialises in this area of law.

If you find yourself in need of assistance with this, or any other legal issue, please contact the law offices of Owen Hodge Lawyers. At Owen Hodge, we are always happy to assist clients in understanding the full ramifications of any and all of your legal needs. Please feel free to call us at your earliest convenience to schedule a consultation at 1800 770 780.

You might also be interested in:

Talk to Owen Hodge Lawyers

Owen Hodge is here to help.

Get in touch now