Where to get forms
- WorkSafe website by accessing the editable PDF version
- their employer
- the local post office
- any Agent
- calling WorkSafe on 1800 136 089.
Completing the Claim Form
The worker must complete all of the questions in Part A of the claim form, except question 7 which is to be completed by the employer. There are no questions that the worker needs to complete on Part B of the form – Part B is for the employer to complete.
The worker must sign the Authority to Release Medical Information and Declaration in the claim form for it to be considered valid.
Types of signatures which are considered valid:
|Method of signature||Claim lodged on employer||Claim lodged directly on Agent|
|Wet ink’ signature||
|Digital image of worker signature (i.e. photo or scan of signature)||
|Typed name or typed signature||
unless employer has indicated they do not know who the claimant is – in this case, treat as direct lodgement on Agent for the purposes of identity verification (see right).
Requires further verification of worker identity for claim to be valid:
Agents should make an appropriate file note where a typed signature has been used on a claim form, confirming which documents have been sighted verifying the worker’s identity.
Note: where claim lodged directly on Agent via a worker legal representative, the Agent can accept a typed signature without further verification.
|Unsigned claim form, emailed with email signature||Invalid||Invalid|
*Agent received date
Where identity documents are required to verify the workers identity, the Agent received date (ARD Agent received date) of the claim form is the date on which the signature can be verified, being the latter of:
the date of receipt of the claim form with a typed signature
the date of receipt of the identity document/s verifying the worker’s identity
A claim lodged directly by a worker, with a typed signature and unaccompanied by a medical certificate The first medical certificate is for a maximum of 14 days and can only be issued by a registered medical practitioner., invoice or payslip is considered an invalid claim, and the invalid claims process should be followed.
See: Invalid claims
Note: Where a worker signs the form electronically, the treating health practitioner (THP Treating Health Practitioner) may not accept the worker’s digital signature as valid. This may cause a delay in the Agent or self-insurer obtaining medical information from the THP. If this occurs, the Agent or self-insurer should take steps to liaise with the THP and worker to obtain a form of signature that will be acceptable to the THP; for example, ask the worker to provide a signed authority in the THP’s preferred form.
See: Valid claims
Assistance to complete a claim form
WorkSafe Advisory Service (WAS) or the Agent can assist the worker to access and partially complete a paper or PDF Worker’s Injury Claim Form.
If the worker requests or needs assistance the following limited set of fields can be completed:
- worker’s full name
- worker’s date of birth
- worker’s full address
- worker’s day time contact telephone number
- employer’s contact name
- employer’s business name
- employer’s business address.
The partially completed copy of the claim form is then sent to the worker requesting him/her to:
- verify the information entered
- provide any outstanding information
- sign and give or serve the claim form on their employer.
Note: Assisting a worker to complete a claim form does not constitute the lodgement of a claim. The worker must still serve the valid claim form on their employer or lodge the claim form directly on WorkSafe or the employer’s Agent if direct lodgement criteria apply. The WAS will also inform the worker that WorkSafe will not keep or save a copy of the partially completed claim form and no record of the call will be maintained.
If a worker is medically unable to sign the Authority to Release Medical Information and Declaration in the claim form (e.g. serious incident leaves worker unconscious or in an induced coma or a worker sustains severe burns to both hands), a Team Manager equivalent (or above) at the Agent or self-insurer can authorise that an unsigned paper or PDF claim form can be lodged.
Alternatively, the following people may sign on the worker’s behalf:
- next of kin
- employer representative
- legally appointed guardian.
Agents and self-insurers must take measures to ensure worker entitlements, if the claim is accepted, are paid to the worker and not to those who have signed the claim form.
As soon as the worker is able to sign the claim form, the previously completed claim form must be returned to the worker requesting their signature.
Worker lodges claim
Workers can serve the claim form (Parts A and B) on their employer.
Workers can also lodge a claim directly on the Agent or WorkSafe if direct lodgement applies. Direct lodgement only applies where a worker becomes aware that an employer:
- has not and is unlikely to forward the claim to the Agent in the time required or
- is refusing to receive the claim or
- cannot be identified after the worker has taken reasonable steps to identify the relevant employer or
- cannot be found after the worker has taken reasonable steps to find the employer
- is dead or is under external administration or has ceased to exist.
The only forms approved by WorkSafe are:
This form is completed by a worker to make a claim for compensation in the form of weekly payments and /or medical and like expenses.
Please note that any old versions of the worker claim form should not be used from 1 July 2021.
MyWorkSafe Portal Worker’s Injury Claim Form
This form is completed by a worker using the MyWorkSafe Portal to make a claim for compensation in the form of weekly payments and /or medical and like expenses.
Use of this form commences 30 May 2022 and is only available to workers employed by:
This form is completed by a worker to make a claim for compensation for non-economic loss.
This form is completed by a worker to make a claim for compensation for maims and/or pain and suffering.
This form is completed by a dependant or another person to make a:
Employer Injury Claim Report to accompany the:
|Certificate of Capacity (to accompany the Worker’s Claim Form if the claim is for weekly payments)||
For a claim for compensation to be valid it must:
- be in an approved form in respect of that type or class of claim
- have an authority to release medical information signed by the worker (except for claims relating to the death of a worker)
- be given to or served on the employer (unless direct lodgement conditions apply) and
be signed by the worker (see: 2.2.1 Worker completes claim form
See: Approved forms
A minimum amount of information is necessary to constitute a valid claim. This should be provided on the Worker’s Injury Claim Form or obtained by WorkSafe Agent via contact with the worker and/or employer to:
- verify the identity of the worker
- identify the employer and
- confirm the incident/injury.
A claim for compensation may be considered to contain a material defect Material defects, omissions or irregularities can affect the decision to accept or reject a claim., omission or irregularity only where the minimum information cannot be obtained as outlined.
Claim for compensation in the form of weekly payments
A claim for compensation in the form of weekly payments must:
- state the date on which the worker ceased work because of the injury or
- be accompanied by a medical certificate or
- be supplemented at a later date by a medical certificate.
To be valid, a medical certificate must:
- be in an approved form
- be issued by a medical practitioner
- specify the expected duration of the worker’s incapacity and whether the worker has a current work capacity Under the legislation, unless inconsistent with the context or subject-matter — current work capacity, in relation to a worker, means a present inability arising from an injury such that the worker is not able to return to his or her pre-injury employment but is able to return to work in suitable employment, declared training program or has no current work capacity
- not contain a material defect, omission or irregularity and
- not exceed 14 days in duration unless there are special reasons which require an extension of that period.
Medical certificate received after claim lodged
Where a claim for compensation in the form of weekly payments was not accompanied by a medical certificate, compensation in the form of weekly payments is not payable unless and until a medical certificate has been given to or served on the employer or lodged with WorkSafe.
If a worker’s Claim Form and a valid medical certificate are not given to or served on the employer on the same day, the claim for weekly payments is considered to have been lodged, however the 28 day ‘deeming’ provisions do not start until the Agent has received the valid medical certificate.
Note: Although the deeming clock has not started it is expected that the Agent will determine liability on the claim within 28 days of receiving the valid claim for weekly payments.