What Happens After I Lodge a WorkCover Claim in Victoria?

Lodging a WorkCover claim in Victoria can feel overwhelming, especially when you’re already dealing with pain, stress, or uncertainty. Whether you’ve suffered a physical injury, a psychological injury, or a long-term work-related illness, understanding what happens next is essential. Many workers in Melbourne and across Victoria feel unsure about the process — what the insurer looks at, how long it takes, when payments start, and what to do if something goes wrong.

This guide breaks down every step in clear, relatable language so you know exactly what to expect after lodging your WorkCover claim. From the moment your employer receives your form to the final decision and beyond, you’ll learn the full process, your rights, timeframes, and how to protect yourself if issues arise.

If you’re worried, confused, or facing a tough insurer or employer, this article will help you feel more in control — and explain how to get legal support if you need it.

Table of Contents

• 1. Your Employer Receives Your WorkCover Claim Form
• 2. Your Employer Must Forward Your Claim to the Insurer
• 3. The Insurer Acknowledges and Begins Assessing Your Claim
• 4. Medical Evidence Is Reviewed
• 5. The Insurer Investigates Your Claim
• 6. You May Receive Provisional Payment for Medical Expenses
• 7. The Insurer Makes a Decision Within 28 Days
• 8. If Your Claim Is Accepted: What Happens Next
• 9. If Your Claim Is Rejected: What Happens Next
• 10. Return-to-Work Planning
• 11. Your Obligations During the Process
• 12. Common Issues That Arise After Lodging a Claim
• 13. When You Should Speak to a WorkCover Lawyer
• 14. Final Thoughts — Where to Get Help

1. Your Employer Receives Your WorkCover Claim Form

After you fill out the Worker’s Injury Claim Form (and attach a Certificate of Capacity if you need time off), the first step is giving the form to your employer. They must accept it — they cannot refuse, argue, or delay the process.

Once they receive the claim:

• they must record the date it was handed in
• they must provide you with a signed copy if requested
• they cannot pressure you to withdraw it
• they must follow strict legal deadlines

This step is essential because it triggers the employer’s legal obligation to send your claim to the insurer.

2. Your Employer Must Forward Your Claim to the Insurer

Your employer has 10 calendar days to forward your claim to their WorkCover insurer.

They cannot:

• delay sending the form
• hide or discard the form
• tell you to “wait and see”
• tell you to use your sick leave instead of WorkCover

If an employer does not send your claim on time, you can send it directly to the insurer yourself. This happens more often than many workers realise, especially in industries with high turnover or less sophisticated HR processes.

Forwarding the claim starts the formal assessment process.

3. The Insurer Acknowledges and Begins Assessing Your Claim

Once the insurer receives your claim, they will contact you — usually within a few business days. Expect a call or email confirming:

• they have received your claim
• the next steps in the process
• what information they may need from you
• your employer’s details
• your treating doctor’s details

They may also send paperwork or request additional information early in the process.

This is the beginning of their formal assessment.

4. Medical Evidence Is Reviewed

Medical evidence is the backbone of any WorkCover claim. The insurer will examine:

• your Certificate of Capacity
• doctor’s notes and records
• hospital or emergency notes (if applicable)
• reports from physiotherapists or specialists
• any scans or imaging

Insurers want to see a clear connection between the injury and your work duties. That’s why it’s crucial to tell your doctor early that your injury is work-related — if it isn’t mentioned in your medical records, the insurer may question it later.

5. The Insurer Investigates Your Claim

The insurer must investigate to confirm whether your injury is work-related and whether you are eligible for benefits. This phase may include:

• reviewing your claim form and medical documents
• contacting your employer for an incident report or their version of events
• interviewing witnesses
• requesting workplace documents or CCTV footage
• speaking to co-workers
• requesting additional medical information from your doctor

In some cases, the insurer may ask you to attend an Independent Medical Examination (IME). This is common for long-term injuries or psychological injuries. While IMEs can feel stressful, they are a routine part of the WorkCover process.

6. You May Receive Provisional Payment for Medical Expenses

Even before a decision is made, insurers often begin covering basic medical expenses under “provisional liability.” This means they may pay for things like:

• GP appointments
• physiotherapy
• basic scans (X-rays, ultrasounds)
• medications

You do not need your claim to be formally accepted before receiving this early support — but not all cases qualify for provisional payments.

7. The Insurer Makes a Decision Within 28 Days

Insurers must make a decision on your claim within 28 days from the date they receive it. They may:

• Accept the claim — meaning you gain access to medical expenses, weekly payments (if required), and rehabilitation support.
• Partially accept the claim — for example, they approve medical costs but dispute weekly payments.
• Reject the claim — meaning they do not accept your injury as work-related or raise other objections.

You will receive a written notice outlining the decision and the reasons for it.

8. If Your Claim Is Accepted: What Happens Next

If your WorkCover claim is accepted, you become eligible for several benefits.

Weekly Payments

If you cannot work or have reduced capacity, you may receive weekly payments. These are generally:

• 95% of your pre-injury earnings for the first 13 weeks
• 80% thereafter

Payments continue as long as you provide updated Certificates of Capacity.

Medical and Like Expenses

WorkCover may cover:

• GP visits
• physiotherapy
• specialists
• scans and imaging
• medication
• psychology counselling
• hospital treatment
• equipment (braces, supports, ergonomic items)

Return-to-Work Support

Your employer must work with you to provide safe, suitable duties. This may include:

• reduced hours
• light duties
• modified tasks
• temporary job adjustments

A Return-to-Work Coordinator or rehabilitation specialist may also become involved.

Lump Sum Entitlements

Depending on your injury, you may later be able to pursue:

• a no-fault impairment benefit
• a common law claim (if employer negligence contributed)

These are separate processes requiring legal assessment.

9. If Your Claim Is Rejected: What Happens Next

If your claim is rejected, do not panic — many WorkCover claims are successfully overturned after review.

Your rejection letter will list the reasons the insurer has refused your claim. Common reasons include:

• the insurer disputes the injury is work-related
• they believe your condition is pre-existing
• late reporting of the injury
• insufficient medical evidence
• disagreements about psychological injuries

You have options to challenge the decision, but strict time limits apply. This is typically the point where legal advice is essential.

10. Return-to-Work Planning

Regardless of whether your claim is accepted or partially accepted, return-to-work planning is a key focus. Victorian law requires employers to:

• assist you in returning to work safely
• offer suitable, modified duties where possible
• avoid discrimination or adverse treatment

Your doctor and the insurer may also provide input on what duties are appropriate.

Remember — you are not required to return to duties that worsen your injury or put you at risk. “Suitable duties” must genuinely support recovery.

11. Your Obligations During the Process

While the insurer has deadlines and responsibilities, you also have obligations, including:

• attending medical appointments
• providing updated Certificates of Capacity
• communicating with your employer about your capacity
• participating in return-to-work planning
• attending Independent Medical Examinations when required

Failing to meet these obligations can impact your benefits — so staying organised is important.

12. Common Issues That Arise After Lodging a Claim

Many workers encounter challenges after lodging a claim, including:

• delayed weekly payments
• employer disagreement over the injury
• insurer questioning medical evidence
• pressure to return to work too soon
• insurer avoiding psychological-related costs
• disputes over suitable duties
• IME assessments that feel unfair

If any of these arise, getting legal help early can make a significant difference.

13. When You Should Speak to a WorkCover Lawyer

Legal advice can be helpful at any stage, but it is especially important if:

• your claim is rejected
• your weekly payments stop suddenly
• the insurer disputes your medical evidence
• your employer is treating you unfairly
• you have a psychological injury
• you may be eligible for a lump sum
• you feel overwhelmed by insurer requests

A good lawyer will:

• explain your rights clearly
• deal with insurers on your behalf
• gather evidence
• challenge unfair decisions
• guide you through complex processes

14. Final Thoughts — Where to Get Help

Lodging a WorkCover claim is only the beginning. Once the insurer receives your claim, a whole process unfolds involving medical assessments, insurer investigations, return-to-work planning and important decisions that impact your future wellbeing and finances.

Understanding the steps helps you feel more confident and in control — but if anything becomes confusing, stressful or unfair, you don’t have to face it alone.

For expert support at any stage of your WorkCover journey, contact Hymans Legal.

Hymans Legal supports injured workers across Melbourne and Victoria with WorkCover claims, disputes, medical assessments and compensation rights.

Phone: 1300 667 116

If you want clarity, confidence and strong representation, reach out to Hymans Legal today.