Victorian WorkCover claims for mental injury – what happens when claims are accepted or rejected

There are key steps you need to take in accessing payments and compensation for your workplace mental injury in Victoria.

If you have suffered a diagnosable mental injury in the course of your employment in Victoria, you will need to lodge a worker's injury claim form with your employer. Here are the steps to complete and lodge the form:

How to lodge a WorkCover claim for mental injury in Victoria

Notify and report

Notify your employer of your injury as soon as reasonably practicable and lodge an incident report or complete the injury register at your workplace.
Request copies of any WorkSafe incident reports and keep your own record of any workplace incident/s that led to your injury.

Seek medical treatment

Seek medical treatment from your medical practitioner and request a Victorian WorkSafe first certificate of capacity. This certificate is valid for a maximum of 14 days and must be submitted with your claim form if:

You can’t do your pre-injury work (this includes your regular hours of work or duties)
You are claiming weekly payments

Complete and submit Victorian WorkSafe worker’s injury claim form

You must complete questions 1 to 6 in Part A of the form. Keep a copy and give the form to your employer to complete question 7 in Part A and question 8 in Part B.
You must also give your employer the original certificate of capacity.
Your employer must provide this information to their WorkCover claims agent within 10 days. Victorian WorkSafe then have 28 days to decide on your submitted claim.
You can download and complete the claim form here:
https://www.worksafe.vic.gov.au/resources/workers-injury-claim-form-pdf-version

What happens after you have lodged your claim form?

If your WorkCover claim is accepted

If your claim is accepted, you will be entitled to receive weekly payments of compensation, medical and like expenses.

Shine may be able to help you further once your Workcover claim lodgement is accepted and you have remained on weekly payments beyond 130 weeks. It is at this point that we recommend you get back in touch with Shine to explore your rights and possibly proceed with a personal injury common law claim.

If your WorkCover claim is rejected or terminated

If your WorkCover claim is rejected or terminated, you have 60 days to appeal the insurer’s decision. This is done by lodging request for conciliation with the Workplace Injury Commission (WIC).

You can complete the claim form here: https://www.wic.vic.gov.au/__data/assets/pdf_file/0011/12602/Application-for-Conciliation-form.pdf

Extensions to the 60 day time limit may be granted in certain limited circumstances.

If the WIC decides to hear your appeal, a conciliation officer will be assigned to you. Your appeal will be listed for a conference (though it may be resolved via telephone without the need for a conference). The conference will be presided over by the conciliation officer whose role is to make recommendations of the ways that the parties may best resolve the dispute.

Solicitors are generally unable to represent you for or attend conciliation conferences. However, WorkCover Assist or Union Assist can attend and support you at a conciliation conference.

What happens when there’s no resolution at a conciliation conference?

Should informal negotiations fail to resolve your dispute at the WIC, the conciliation officer may either:

Elect to issue a Certificate of Genuine Dispute, or
Make a referral to the Medical Panel (if the dispute relates to a medical question)

Certificate of Genuine Dispute

A Certificate of Genuine Dispute entitles you to refer your matter to the Workers’ Compensation Independent Review Service (WCIRS) or issue court proceedings (should you wish to progress your dispute). To apply for independent review via the WCIRS, complete the claim form here.

The WCIRS must review the insurer’s decision within 30 days of receiving the Certificate of Genuine Dispute.

There is no timeframe in which to issue court proceedings, but once issued, you could expect the matter to be listed for hearing within 6 to 12 months. If the matter proceeds to court and the judge concludes that a dispute relates to a medical question, then the judge may refer your matter to the Medical Panel for a final determination.

Medical Panels

Should your dispute be sent to a Medical Panel for determination, you would be examined by a board of independent medical practitioners who then answer the disputed medical questions relevant to your injury. In answering the questions before them, the Medical Panel give a final and binding opinion regarding the medical question in dispute.