Questions and Answers - Workers Compensation | QBE Insurance Australia
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Questions & Answers

Workers Compensation Insurance

This information is specific to QBE Workers Compensation insurance policies. If you have a more general question about your insurance, please contact us.

Q. How do I get a copy of my Certificate of Currency?

View the following state based information:

Q. What will QBE do when I submit a claim?

A. A QBE Case Manager will be allocated to the claim to contact the employer, injured worker and their treating doctor within 48 hours of receiving the required documentation. The Case Manager will obtain the necessary information to determine the liability of the claim. The Case Manager will assist you with all aspects of the claim, including co-ordination of the treatment and return-to-work process, to ensure that the injured worker is able to return to work in a safe and durable manner.

Q. What must an employer do when an employee sustains a work related injury?

A. An employer must:

  • ensure the injured worker has access to first aid and medical treatment
  • assist the injured worker to lodge a claim firstly by providing them with a claim form
  • lodge the claim with their insurer promptly and no later than 5 days after it has been received, including the claim form and Medical Certificate from the injured worker
  • keep the injured worker’s pre-injury job available to allow and encourage them to return to work
  • in consultation with the injured worker, their treating doctor and QBE, develop a return-to-work program to enable the injured worker return to work.

Q. Does an employer have to lodge a claim with their insurer if an employee sustains an injury?

A. If an employee sustains an injury and receives a Medical Certificate from a registered medical practitioner, the employer is required to provide a workers compensation claim form for the injured worker to complete. If the injured worker decides to lodge a claim on their employer, they must serve their completed claim form and First Medical Certificate on their employer. If this occurs, an employer is required to submit the claim to their insurer. The claim must be submitted to the insurer regardless of any dispute the employer and injured worker may have about the injury.

Q. As an injured worker, do I have to lodge a claim if I have sustained an injury in the workplace?

A. If you have sustained a work-related injury, you may be required to take time off work and receive medical treatment. If you expect to be reimbursed or compensated for these expenses by your employer and their insurer, you must lodge a claim for workers compensation. An injured worker cannot be forced to lodge a claim. However, injured workers must be aware that failure to notify their employer of an injury or failure to make a claim for compensation within legislated time periods may jeopardise their entitlement to compensation.

Q. Why is it important to notify QBE of an injury and submit a claim quickly?

A. Research clearly shows that a delay in reporting an injury or a delay in submitting a claim results in poorer outcomes for injured workers and increased costs for employers. Prompt reporting of injury and submission of a claim allows for:

  • funding of timely medical treatment
  • prompt re-imbursement of lost wages
  • timely implementation of injury management and return-to-work initiatives

Q. Will all of an injured worker’s medical expenses be paid for by the insurer or could they incur out of pocket expenses?

A. If a worker has an accepted claim for a work-related injury an insurer is required to pay for reasonable medical expenses for that work-related injury only. In addition, insurers are only obliged to pay the prescribed fees published by WorkCover Authority. In some cases, the doctor or other treatment provider may charge in excess of the prescribed fee. In such cases the “gap” is not payable by the insurer or the employer. Injured workers should check with their doctor or treatment provider regarding fees charged to ensure they will not incur out of pocket expenses.

Q. Can an injured worker choose their own doctor for treatment of a work-related injury?

A. Yes. However, an employer may have appointed a company doctor or medical centre that is familiar with their workplace to look after any of their employees should they sustain an injury. An injured worker may choose to be treated by a company doctor, either initially or on an ongoing basis, or they may choose to see their own doctor initially or on an ongoing basis.

Q. Can an employer or their insurer require an injured worker to attend a doctor of their choice?

A. Yes. When a claim for compensation is made by an injured worker, an employer or their insurer may require the injured worker to be reviewed by a doctor chosen by the employer or insurer, but not more frequently than every 14 days. The purpose of such medical reviews is not to administer treatment, but rather to provide medical opinion and information to assist the return-to-work process. Medical treatment can only be administered with the consent of the injured worker by their nominated treating doctor.

Q. Do I have to have a vocational rehabilitation provider involved in a claim?

A. No. In the first instance, the key parties to a claim (the injured worker, employer, treating doctor and QBE) are required to work together to ensure a safe and durable return-to-work outcome for the injured worker. However, where there are complexities or barriers to achieving this, an appropriately qualified and skilled vocational rehabilitation provider may be appointed to assist the key parties to achieve a return-to-work outcome. Regardless, all parties remain involved in the return-to-work process.

Q. What do I do if I disagree with action taken by QBE?

A. QBE’s approach is to work with all stakeholders in an open and honest manner to achieve outcomes that are in the interests of all parties. We encourage all stakeholders to contact us if they have concerns regarding a claim or any other issue affecting them due to action taken by QBE. QBE has strict review procedures in place for all key decisions that affect injured workers, employers and service providers. In addition, QBE is required by law to have internal dispute resolution procedures in place. This process allows for review of decisions made by your QBE representative. Contact QBE immediately if you require a review of a decision or action by QBE.

Taking Out A Policy

Q. Does QBE offer employer training in workers compensation and premium management issues?

A. QBE Risk Management offers employers a comprehensive range of national Occupational Health and Safety (OHS) and Risk Management services. The team has extensive experience across a wide range of industries and organisations and can assist your employer to:

  • develop a systematic framework to mitigate or manage risk and reduce workers compensation costs
  • analyse performance to identify key cost drivers
  • build a strong organisational health and workplace culture
  • set goals, drive improvement strategies and implement line management accountability for OHS requirements
  • comply with OHS and workers compensation legislation.

Contact your local OH&S Risk Manager to discuss how we could help or refer to employer training section for list of courses.

Q. Is a worker covered when working interstate or overseas?

A. The Parliaments of the ACT, NSW, Queensland, Tasmania, Victoria, Western Australia and South Australia and the Northern Territory Government have all passed legislation consistent with a national model.

A National Model

The fundamental aims of the national model are to:

  • ensure an employer only needs to register a worker in one scheme and one scheme only, irrespective of temporary movements interstate
  • ensure that a worker is connected to one jurisdiction
  • ensure a worker temporarily working in another State has access to workers compensation entitlements available in their “home” jurisdiction (including arrangements applying in relation to common law)
  • ensure a worker has certainty about their workers compensation entitlements
  • eliminate ‘forum shopping’ by a worker potentially covered in multiple jurisdictions

The national model requires an employer to obtain workers compensation insurance for a worker in the worker’s State of connection. The State or Territory in which workers compensation insurance and benefits relating to a particular worker are payable is referred to as a worker’s State of connection. See QBE Fact Sheet

Q. Are sole traders covered by their own policy?

A. Sole traders are people who work for themselves but have not formed a company to work under. Unless sole traders can be regarded as working directors, they cannot cover themselves for workers compensation. If a sole trader has workers, they must take out a workers compensation policy, but they will not themselves be covered by this policy. Sole traders should consider taking out a personal accident and illness policy or an income protection policy.  We recommend getting professional advise.

For more information download a copy of the Workers Compensation Insurance Proposal

Q. Are contractors deemed workers under workers compensation policy?

A. Contractors may be deemed a worker for the purposes of workers compensation. This may depend on various criteria such as:

  • whether they work for one employer or many;
  • whether they delegate work to others or not; or
  • if they employ staff.

Please refer to respective WorkCover authority in your state or territory for additional information and definition of a worker applicable to legislation in your state.

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