Making a Workers Compensation Claim

Introduction

This page outlines the procedures for making a workers compensation claim at the University of Adelaide. Detailed information is available in the University policy on Rehabilitation.

• When to Claim
• How to Claim
• Responsibility for Expenses
• Income Maintenance
• Acceptance of Claims
• Reimbursement for Medical Expenses
• Other Expenses
• Rehabilitation Assistance
• Further Information

When to Claim

If employees are injured while carrying out their work duties they are entitled to lodge a workers compensation claim. Lodging a claim does not imply any commitment to acceptance of the claim or of liability. You are required to notify your Manager/Supervisor as soon as possible.

How to Claim

Step 1: Consult a doctor (registered medical practitioner). You must advise the treating doctor that the injury is work-related and obtain a Workers Compensation Medical Certificate (formally known as a PMC) from the doctor.  Your treating doctor will decide if you (1) need time off work (2) have any restrictions (3) if modifications to your employment are required or (4) if/when you are fit to return to normal duties.  A WorkCover Medical Certificate (PMC) is required to lodge a claim for compensation and is part of the mandatory information required.

Step 2: Complete a Claim form.  A Claim form is required if you wish to notify the University that you have suffered a compensable injury at work. 

Step 3: Forward your Completed Workers Compensation Medical Certificate and Claim form to:

Health Safety and Wellbeing
Human Resources
Level 13, 115 Grenfell Street
Adelaide 5005

Responsibility for Expenses

The University is responsible for all medical and associated costs until the claim has been determined. Accounts should be addressed to the employee, not The University of Adelaide. 

Income Maintenance

Income Maintenance payments are made at a rate equal to your Average Weekly Earnings for the 12 months prior to your injury.

• The average weekly sum is paid for the first 13 weeks
• At 13 weeks there is a reduction in payments to 90%
• At 26 weeks there is a reduction in payments to 80%

In calculating your pre-injury Average Weekly Earnings, your ordinary rate of pay per week is taken into account, along with regular shift penalties, overtime and allowances (where applicable).

When income maintenance is stopped or reduced
Your income maintenance may be discontinued/reduced in these circumstances:

• When your doctor is satisfied that you are fit for work (ie no longer incapacitated);
• If you are dismissed from your job for serious and wilful misconduct;
• If you commit a “Breach of Mutuality” which may include not co-operating with a rehabilitation and return to work plan, not performing suitable duties provided by the University, not providing medical certificates or not attending medical appointments reasonably required by the Claims Manager.

Please note that if, after 130 weeks you are still receiving income maintenance, your entitlement to payments will be reviewed under a work capacity test. 

Acceptance of Claims

When your claim has been accepted, you will receive a formal advice from the Claims Manager.
You are required to accept the provision of safe and suitable employment as prescribed by your doctor, actively participate in the planning and implementation of a rehabilitation and return to work program (if applicable) and attend medical and rehabilitation appointments as requested by the Claims Manager.  If you have a problem with the determination, you are entitled to lodge a dispute.  Information will be provided on the determination letter.

Reimbursement for Medical Expenses

Please forward all medical expenses relating to your treatment to the Health Safety and Wellbeing Specialist, Human Resources, Level 13, 115 Grenfell Street, Adelaide 5005.  They will be forwarded to the Claims Manager for determining and then processed by our Finance Branch.  If you have paid for any expense then you will be reimbursed via direct credit into your bank account. 

Other Expenses

Travel expenses and pharmaceutical expenses are claimed using a form that can be obtained from Health Safety and Wellbeing.  This form will be included in your Claims/Rehabilitation pack which you will receive when you first lodge your Claim Form.  Please telephone 8303 5904 for further assistance.

Rehabilitation Assistance

The University will provide you with a co-ordinated return to work program based on the information provided by your Medical practitioner.  To assist in this process:

• Ask your doctor to detail the work you can/can’t do on your WorkCover Medical Certificate.  The list should include details of any limitations (eg difficulty with bending, lifting with weight restrictions, hours worked or requirements for regular breaks).
• Keep your Manager/Supervisor informed if you are having any problems with you return to work arrangements or duties.

Your rehabilitation will be co-ordinated by the Health Safety and Wellbeing Specialist.  A qualified rehabilitation consultant may also be engaged to assist in your return to work.

Who can I contact if I have any other questions?

Your contacts are:

Further information is available on the WorkCover website.