This document outlines the 4 step process for an employee at Young and Well CRC to make a WorkCover claim for a work-related injury or illness. Step 1 involves seeking treatment, notifying the employer and keeping records. Step 2 is making the official claim by submitting forms and certificates. Step 3 details the process after a claim is accepted or rejected. Step 4 covers return to work and payment changes over time. The checklist provides guidance on documentation, approvals, entitlements and employer/insurer responsibilities at each stage of the claims process.

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WorkCover Claim Checklist – Employee:
Step 1: Seek appropriate treatment
 Keep copies of all treatment invoices and receipts
 Notify Young and Well CRC’s Occupational Health & Safety Officer
- Record injury or illness in workplace’s Register of Illness Form within 30 days of
you first becoming aware of it or you may not be entitled to compensation (If you are
unable to record your injury or illness in the Register of Illness Form, you still need to
notify Young and Well CRC OHS Officer in writing within 30 days of becoming aware
of your injury or illness)
- Keep Young and Well CRC informed about any time away from work that you
may need, or any assistance that you need to return to safe work (reduced hours or
modifications to your duties or work area)
- With incidents related to motor cycle, employees should inform Police Officer
immediately
Step 2: Making a claim
 Obtain a Certificate of Capacity which is issued by a medical practitioner
and make sure you sign for it to be valid
- Your first Certificate of Capacity is obtained from a medical doctor (covers a
maximum of 14 days)
- Your ongoing Certificates are obtained from a medical doctor, chiropractor,
physiotherapist or osteopath (covers a maximum of 28 days)
 Report motor vehicle-related accidents to police
 Complete the Worker’s Injury Claim Form – ensure that you list all injuries or
illnesses related to your claim for compensation
 Submit the claim form to Young and Well CRC with your Certificate of Capacity
by hand delivering or posting
- Request a copy of the claim form with ‘Employer Lodgement Details’ section
completed by Young and Well CRC
- Ensure Young and Well CRC submit your claim to their WorkSafe Agent within 10

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calendar days of receiving it
 Attend independent medical examinations if required
 Provide a statement of your injury if a Circumstance Investigator is appointed
to obtain information from witnesses about your claimed injury
 Receive a decision within 28 days from the date WorkSafe Agent received your
claim from Young and Well CRC
Step 3: After the claim has been assessed
3.1: If your claim has been accepted
 Continue to send Certificates of Capacity to Young and Well CRC
 Request referral or approval from a medical practitioner or WorkSafe Agent
before accessing certain treatments
- Access services without a referral or initial approval: ambulance, chiropractic,
dental services, family counselling, MRI scan, optometry, osteopathic, physiotherapy,
podiatry
- Access services with a medical referral or with prior approval:
Medical practitioner referral: acupuncture, audiology, dietetics, exercise
physiology, household help, grief and loss counselling, naturopathy, nursing,
occupational therapy, psychology, remedial massage, social work, speech pathology
WorkSafe Agent approval: attendant care, aids and appliances, community access,
child care, car modifications, elective surgery, equipment, external case management,
hearing device, home exercise equipment, home modifications, gym or swim
programs, implantable pain therapy, network psychology, pain management
program, network pain management program, private psychiatric hospital, removalist
costs, respite care
 Send your treatment invoices or receipts to Young and Well CRC until advised
otherwise so Young and Well CRC can pay an excess before the WorkSafe Agent takes
over paying the reasonable costs of your treatment
 Send your treatment invoices or receipts to the WorkSafe Agent once Young
and Well CRC has paid the excess amount
 Ask your treatment provider to bill Young and Well CRC or WorkSafe Agent

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directly because WorKSafe will only pay for the approved cost of treatment
3.2: If your claim has been rejected
 Talk to Young and Well CRC, your treating health practitioner or the WorkSafe
Agent
 Request your WorkSafe Agent to undertake a review of a decision they have
made. This review is made by a senior person within the WorkSafe Agent who was
not involved in the original decision
 Contact the Accident Compensation Conciliation Service if you are not happy
with the decision after review
Step 4: After your accepted claim
 Provide Young and Well CRC with a clearance certificate – a Certificate of
Capacity where your treating health practitioner will indicate that you are ready to
return your pre-injury work
 Be aware of weekly payment changes at 13 and 130 weeks
- For the first 13 weeks: 95% of employee’s pre-injury average weekly earnings
(PIAWE) to a maximum of twice the State average weekly earnings – currently $2,130
a week
- 14 weeks to 130 weeks: 80% of their PIAWE to a maximum of twice the State
average weekly earnings – currently of $2,130 a week
- After 130 weeks: 80% of their PIAWE to a maximum of twice the State average
weekly earnings – currently $2,130 a week, if they still cannot work and this is not
likely to change. Payments may continue until retirement age unless there is a change
in the employee’s capacity
The relevant period for the purposes of an employee’s PIAWE is usually 52 weeks
before the injury. If an employee has been with Young and Well CRC for less than 52
weeks, the relevant period is the period of employment
 Be aware of the change in your employer’s obligations at 52 weeks
- Young and Well CRC is required, within reason, to maintain employment for a
period of 52 weeks while the employee have an incapacity for work. This may not
necessarily be a period of 52 consecutive weeks. After this period, Young and Well

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CRC has no obligation under Victorian workers’ compensation legislation to re-
employ the employee