Workers’ Compensation – Workplace Injury

Once a claim has been lodged

A school’s responsibility to support an injured worker’s recovery and return to work begins as soon as the worker’s certificate of capacity or claim form for weekly payments is received, or from the date the school is advised by the agent that they have received these documents. A claim does not need to be accepted for the school’s responsibility to support that worker to begin.

The return to work coordinator must:

• support the worker through their return to work journey
• encourage the worker to access appropriate medical intervention as soon as convenient
• build a working relationship with the treating health practitioner of the worker to build awareness of their functionality and work capacity, including restrictions and capabilities.

Training is available to support return to work coordinators in their role. Refer to the Resources tab for further information.

Provisional payments

Workers who are claiming they have sustained a mental injury at work can access early treatment and support while they wait to hear if their claim has been accepted. Access (and payment) for this early treatment is called provisional payments and they can be accessed by the injured worker for reasonable treatment and services for up to 13 weeks, even if their claim is rejected. This gives workers a better chance of a full recovery and reduces the risk of exacerbating their injury.

The agent will notify the worker of whether they are entitled to provisional payments, usually within 5 business days of the claim being lodged.

For information about supporting the injured worker, entitlements to provisional payments, and step-by-step advice, see WorkSafe Victoria’s Provisional payments: information for employers guidance.

Claim classification

When a claim has been lodged, the agent will confirm receipt of the claim by email, and will provide the return to work coordinator and injured worker with a claim number. The confirmation email will note whether the claim has been registered as a:

• minor claim: unlikely to exceed 10 days of time off work
• standard claim: has or will exceed 10 days of time off work and it has been accepted
• pending claim: the claim is under review by an eligibility officer to determine liability, awaiting further investigation (see further information below).

The agent will decide if a claim is accepted or rejected, based on workers’ compensation law. The agent will inform the injured worker and the return to work coordinator of the decision. A worker has the right to appeal a decision of the agent (refer to the Dispute resolution chapter). The return to work coordinator can support the injured worker through this process.

Pending claims

Where the agent decides that a claim requires investigation before making a decision, and further information is requested from the worker or the department to inform the decision, the agent will mark the claim as a 'pending' claim.

The agent has up to 28 days to determine whether or not to accept the claim. If a decision cannot be made by day 28, they will mark the claim as pending and discuss this with all parties.

If the return to work coordinator believes a claim should be made a pending claim (for example, to allow for the acquisition of further information), they must notify the agent at the time of forwarding the workers’ injury claim form to assist the agent with their review.

During the pending phase, the return to work coordinator must:

• start return to work planning without delay
• send all received paperwork including certificates of capacity, invoices and accounts to the agent and retain copies
• not pay compensation for wages until a liability decision has been made. The interim workers’ compensation leave codes to use for a claim in the pending phase are 637/655
• if notified that the claim is rejected, follow the further instruction that is provided by the agent
• if the worker is entitled to provisional payments, they can claim the reasonable costs of treatment for their claimed mental injury (see ‘provisional payments’ above). Invoices should be provided to the agent for reimbursement directly to the worker.

If a claim is marked as pending, the agent may request further information in the following ways:

• Independent medical examination – an independent medical examination may be arranged to seek an independent medical advisor’s comment on the worker’s clinical diagnosis and current work capacity and to determine whether the claimed injury is work-related. This report can help to determine medical, treatment and claims liability as well as entitlement issues.

• Circumstance investigation – a circumstance investigation may be arranged to determine the facts surrounding an injury to support the agent’s decision about whether a claim should be accepted. The investigators may ask for the following documents or information from the return to work coordinator:

  • leave records
  • pay history
  • conduct issues
  • statement of expectations
  • contract of employment
  • employment history
  • results of any pre-employment medical examination
  • current position information (job description)
  • eduSafe Plus reports/incident reports
  • relevant policies relating to the claimed injury
  • prior claim or injury information
  • investigators may also request to take photos or access CCTV footage if relevant to the injury circumstances.

  Part of the investigation will involve seeking witness statements from the injured worker, staff mentioned in the claim form and the return to work coordinator. This will involve the circumstance investigator asking to conduct witness interviews with people who might have information about the claim. There is no obligation for any person to provide a statement, however if a statement is provided, the investigator will seek information to understand the sequence of events leading up to the injury, and any information that is related to the incident or injury.

• Treating Health Practitioner information – the agent may request clinical notes and/or a report from the treating health practitioner to gather information about the claim.

If the agent decides to reject the claim after the pending stage, the injured worker has the right to appeal (refer to the Dispute resolution chapter).