How does the claims process work?
What to do when an • The employer should What to pay and when
accident occurs send the form and
When approval is granted
certificate to the insurer
• The worker should be by the insurer, the employer
within three working days.
encouraged to seek should determine the
medical attention from • Establish a return to work amount of the workers’
a medical practitioner program (if the worker’s compensation payments
of their choice as soon doctor indicates that and begin making
as possible and obtain a one is required). them without delay. The
First Medical Certificate. employer is required to
Insurer responsibilities pay the worker in the usual
• The employer should
manner and frequency,
then provide the injured The insurance company
unless notified by the
worker with a Workers’ must assess the claim and insurer to cease payments.
Compensation Claim advise the employer and
Form (2B), which they injured worker in writing The employer may pay
complete. This form within 14 days of receiving accrued leave
is available from the the claim, whether it is (annual or sick leave)
insurer or WorkCover WA accepted, disputed or if to the injured worker
if the employer is unable they need more time to while the claim is being
to provide it. decide. assessed. However this is
a voluntary option that
• When the First Medical If the insurer fails to reply must be approved by the
Certificate and within 14 days, the worker worker and is not workers’
completed Workers’ becomes entitled to weekly compensation. If the claim
Compensation Claim compensation payments is approved and payment
Form (2B) are received until a date determined from accrued sick leave
by the employer, the by an arbitrator from entitlements has been
employer’s section of WorkCover WA. made, these entitlements
the form should be
If the worker has not must be refunded to the
completed and the
received notification or employer and credited to
date which they were
the first weekly payment the worker.
received by the employer
within 17 days of lodging All accounts and invoices
should be recorded.
the claim, the matter is relating to medical
• The employer should deemed to be in dispute treatment and other
detach the front and the worker may bring approved entitlements
cover of the Workers’ the matter to WorkCover must be forwarded to the
Compensation Claim WA’s Dispute Resolution insurer as soon as possible.
Form (2B)and give it to Directorate.
the worker as this provides
Choice of medical practitioner Insurer
A worker may attend a medical • Has 14 days after the claim is made
practitioner of their own choice for by the employer to make one of the
treatment and management of their following three decisions on liability.
work-related injury. • The insurer must notify the worker
and the employer, in writing, of
Is the injured worker’s job kept open? their decision and the reasons and
If a worker attains a capacity for work legislative base for their decision.
within 12 months of the day they became
entitled to weekly compensation Liability accepted
payments, the employer must make the The injured worker’s
position they held available to them, if entitlements may include:
this is reasonably practical. If the position • weekly payments
is unavailable or the worker is unable • medical expenses
to perform that job, the employer must • vocational rehabilitation
provide a similar position that the worker • travel expenses
is qualified for and capable of performing • a specialised retraining program
and that is comparable in status and pay. (in special cases)
Should the employer wish to terminate • lump sum settlements where appropriate.
a worker within the 12 month period, the Liability disputed
worker and WorkCover WA must be given 28
days written notice of the employer’s intent. The injured worker may lodge an application at
the Dispute Resolution Directorate to review the
Simple guide to the claim process
Decision on liability unable to be made
Worker The insurer must notify the Dispute Resolution
• Seeks first aid. Directorate that liability has not been decided.
If there is still no decision after a further 10 days,
• Reports incident. the claim is deemed to be in dispute and the
worker may refer the matter to the Dispute
• Obtains a First Medical Certificate from Resolution Directorate.
a medical practitioner of their choice.
• Completes, signs and submits a If the insurer does not respond after 14
Workers’ Compensation Claim Form days from receiving the claim, the worker
(2B)and the First Medical Certificate to becomes entitled to weekly payments of
their employer. compensation until the Dispute Resolution
Directorate orders, or the parties agree
otherwise. The insurer is liable to indemnify
• Completes employer section of the the employer for these payments. Either
Workers’ Compensation Claim Form the injured worker or the employer may
(2B). Gives information tear-off section refer the application to the Dispute
to worker. Resolution Directorate.
• Sends Workers’ Compensation Claim
Form (2B)and First Medical Certificate to Disclaimer
their insurer within three working days. This fact sheet is intended to provide general
information only. You should not act or omit to act
• Establishes a return to work program (if on the basis of anything contained herein. You
the worker’s doctor indicates that one should seek appropriate legal/professional advice
is required). about your particular circumstances.
Dec. 2009 0290-2007-01
2 Bedbrook Place telephone 08 9388 5555
Shenton Park facsimile 08 9388 5550
Western Australia 6008 advisory services 1300 794 744
www.workcover.wa.gov.au TTY 08 9388 5537
wa.gov.au email firstname.lastname@example.org