This document provides guidance for medical practitioners on completing workcover medical certificates. It addresses key areas such as documenting diagnoses, assessing work capacity and rehabilitation plans. Practitioners are advised to consider the health benefits of work when certifying capacity, provide clear work restrictions, and identify barriers to timely return to work in order to facilitate claim processing. Confidentiality and obtaining appropriate consent for information sharing with insurers is also discussed.

1. What
restric+ons
should
I
put
on
a
Workcover
cer+ficate?
Dr
Angus
Forbes
Occupa+onal
Physician

2. • Work
related
consulta+ons
2.5
/
100
GP
encounters
(2009)

3. Medicine
• Early
diagnosis
and
management!
• Pa+ent
advocacy

4. Why
bother?
• Timely
processing
of
claims
• Enhances
effec+ve
communica+on
• Pa+ent
expecta+ons

5. WHSQ12278
Form 86.R
Version 5
Queensland workers’ compensation
medical certificate
Workers’ Compensation and Rehabilitation Act 2003
Parts A and E of this medical certificate comprise an approved form under the
Workers’ Compensation and Rehabilitation Act 2003.
INSTRUCTIONS: Tick if applicable, and fill in the information as requested.
New claim Claim number:
Part A - Worker’s details
I certify that on DD /MM / YYYY I attended to (given names)
(surname) Date of birth DD /MM / YYYY
Worker’s daytime contact phone number:
Worker’s employer name:
The worker is/was suffering from (list all medical diagnoses relevant to the claim):
Diagnosis:
This is a provisional diagnosis (if provisional complete Part B)
Worker was first seen at this practice/hospital for this injury/disease on: DD /MM / YYYY
Worker stated date of injury: DD /MM / YYYY
Worker’s stated cause of injury (if not previously supplied):
Injury/disease is consistent with worker’s description of cause: Yes Uncertain
Detail any pre-existing factors or condition aggravated by the event (if not previously supplied):
Worker’s capacity for work (not only pre-injury duties)
Please consider the “health benefits of work” when certifying the worker’s capacity.
To return to normal duties from: DD /MM / YYYY
For suitable duties from: DD /MM / YYYY to DD /MM / YYYY (complete Part D)
No capability for any type of work DD /MM / YYYY to DD /MM / YYYY (complete Part C)
Estimated time to return to some form of work duties: Days Weeks Unsure
Medical management
Worker will require treatment from: DD /MM / YYYY to DD /MM / YYYY (complete Part C)
Worker will be reviewed again on: DD /MM / YYYY
No further review
Part B - Worker’s details
I have ordered: Diagnostic imaging Pathology Other investigations
Details:
Part C - Medical management plan
Treatment:
Medication prescribed:
Referred to specialist (speciality/name):
Referred to allied health professional (discipline/name):
Detail (specify):
I would like the insurer to arrange a case conference with (tick more than one if appropriate):
Treating practitioner Treating Specialist Treating Allied Health Employer
Employer has been contacted I would like the insurer to contact me
Further information:
Part D - Rehabilitation and return to work plan
Approval is given for a suitable duties program with the following guidelines
No Occasional Frequent Comments
Lifting: weight limit kg
Bending/twisting/squatting:
Standing/sitting:
Use of injured hand/arm:
Pushing/pulling:
Operating machinery/heavy vehicle:
Driving a car:
Keep wound clean and dry
Other considerations (specify):
Restrictedhours/days(specify):
I require a suitable duties program to be provided to me for approval
Part E - Medical/Dental practitioner details (please print clearly or use practice or hospital stamp)
Doctor’s name: Practice/hospital name:
Postal address:
Preferred method of contact: Phone: day(s)/time(s)
Fax: Email:
Signature: Date: DD /MM / YYYY
Practice/hospital
stamp here
www.qcomp.com.au
Claim enquiries:
WorkCover Queensland 1300 362 128
Self Insurance or other enquiries 1300 361 235
Under the Workers’ Compensation and Rehabilitation Act 2003 and earlier Queensland workers’
compensation legislation, the workers’compensation insurer is authorised to collect the information
on this form to process the claimant’s application for compensation. Some or all of the information
contained in this form may be disclosed to the claimant’s employer, another insurer, medical or allied
health providers or any other workers’compensation authority in any jurisdiction.
This form was approved by the Workers’Compensation Regulator, on 11 April 2014, pursuant to
section 586 of the Workers’Compensation and Rehabilitation Act 2003.
© State of Queensland (Department of Justice and Attorney-General) 2014
Great state. Great opportunity.
Workers’ Compensation Regulator
Department of Justice and Attorney-General

6. The
health
benefits
of
work
2011
• Good
work
is
good
for
you
–
Re-­‐employment
improves
markers
of
general
health
and
esteem
– Re-­‐employment
reduced
psychiatric
morbidity

7. The
health
benefits
of
work
2011
• Non
work
is
dangerous
– Increased
mortality
(especially
suicide
and
CVD)
– Increased
rates
of
CVD,
lung
cancer,
mental
health
condi+ons,
disability
– Increased
rates
of
sickness,
future
worklessness
in
children

8. The
health
benefits
of
work
2011
• Off
work
20
days
–
70%
of
ever
ge[ng
back
• Off
work
45
days
–
50%
of
ever
ge[ng
back
• Off
work
70
days
–
35%
of
ever
ge[ng
back

9. Barriers
to
return
to
work
• Health
professionals
• Employers
• Insurers
• Pa+ents

10. Work
related?
• You
don’t
have
to
make
that
determina+on
• You
are
asked
whether
you
think
the
mechanism
and
injury
are
consistent

11. Diagnosis
• Pain
is
a
symptom
– It
may
be
all
you
have,
but
what
is
the
management
plan

12. Suitable
du+es
• Work
capability
• What
would
they
do
at
home?
• Host
employment

13. Confiden+ality
• Signing
claim
form
they
are
providing
an
authority
to
release
informa+on
to
the
insurer
about
the
mader.
• Addi+onal
informa+on
needs
separate
authority

14. Workcover
gripes
• Illegible
• Inadequate
details
(work
restric+ons)
• Incomplete
form
• Inappropriate
diagnosis,
jargon,
abbrevia+ons
• Delay
in
iden+fying
yellow
flags