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Claiming workers compensation in Victoria is often spoken about as a single step. In practice, it is not. Most people focus everything on getting their claim accepted. What comes after is often less clear.
Weekly payments, medical certificates, return-to-work plans and ongoing obligations can all feel unfamiliar, and the pressure to navigate them correctly falls on you at a time when you are already managing an injury. In our experience, workers compensation claims often hit their hardest stretch after the approval letter arrives, not before.
This guide explains what happens after workers compensation claims are approved in Victoria, what you are entitled to, what is expected of you, and what can affect your payments over time. It is not legal advice for your specific circumstances. If you want to understand where your matter sits, call us. The first conversation is obligation free.
When WorkCover approves your claim, the decision comes from the insurer agent managing your file. Approval means they have accepted that your injury is work-related and that you are entitled to benefits under the Accident Compensation Act 1985 or the Workplace Injury Rehabilitation and Compensation Act 2013. What those benefits cover depends on your injury, your capacity to work, and how your claim progresses.
Approval is not the end of the workers compensation claims process. It is the beginning of a different, longer one. Here is what can happen.
After approval, most workers compensation claims move through these stages:
If your injury means you cannot work, or can only work reduced hours, you become entitled to weekly payments. When you are claiming workers compensation in Victoria, these are calculated as a percentage of your pre-injury average weekly earnings, with the rate and applicable period.
The rate of weekly payments decreases at defined points across the life of a claim, and a further test applies further down the track. The exact rates and timeframes are prescribed by legislation. We explain what currently applies to your circumstances when we look at the file.
To receive payments, you need to maintain a current Certificate of Capacity. This is a form completed by your treating practitioner certifying your work capacity and ongoing treatment needs. If your certificate lapses, payments can stop.
The calculation of your pre-injury earnings can also be disputed. If you believe your payments are not being calculated correctly, that is worth raising early, and worth getting advice on if the insurer’s response is unsatisfactory. We may be able to assist you with an appeal, if the calculation is wrong. There are time limits to appealing these decisions so it is worth speaking with us as soon as practicable.
WorkCover covers reasonable medical and treatment costs connected to your accepted injury. These can include:
Expenses need to be submitted to your insurer with receipts and invoices. Insurers can and do dispute whether particular treatment is reasonable and necessary. If they refuse to cover something, you have the right to challenge that decision. There are time limits to appealing these decisions.
Claim approval does not pause your return-to-work obligations. In Victoria, your employer is legally required to provide suitable employment where it is available. This means duties that are appropriate to your work capacity and do not put your recovery at risk.
Suitable employment might mean reduced hours, lighter duties, modified tasks, or a temporary change in role. Your Certificate of Capacity guides this process. Your treating doctor certifies what you can and cannot do. At times, the insurer may also arrange an Independent Medical Examination to provide an opinion on your work capacity.
A Return to Work Coordinator may be appointed, either from within your workplace or through an external provider. Their role is to coordinate your rehabilitation and return-to-work plan. You are expected to participate actively in this process. But “suitable” means something specific under the legislation. You are not required to return to tasks that worsen your injury or that are not genuinely appropriate to your current capacity.
If your employer is pressuring you to return before you are ready, or is not meeting its obligations, speak to a lawyer. These situations can escalate quickly and become harder to address after the fact.
The insurer may decide to terminate your payments. It may be possible to appeal this decision. Time limits apply, so speak to your lawyer early.
Claiming workers compensation does not end when the claim is accepted. Approval comes with ongoing responsibilities. The main ones are:
Keeping your Certificate of Capacity current. A gap in certification stops payments. An updated certificate from your treating doctor is usually all that is needed to restart them, but the interruption can cause real hardship.
Participating in return-to-work activities. This includes engaging with your employer’s offers of suitable duties, attending meetings with the Return to Work Coordinator, and following a return-to-work plan where one is in place.
Attending an Independent Medical Examination if requested. Your insurer has the right to request an examination by a doctor of their choosing. Failing to attend without a legitimate reason can affect your entitlements. If you have concerns about a scheduled examination, getting legal advice before you attend is sensible.
Claims do not always run smoothly. The most common reason payments stop is a lapse in your Certificate of Capacity. The fix is usually straightforward, but the disruption can create financial difficulty quickly.
Insurers also review workers compensation claims regularly. They may obtain their own medical evidence and form a different view of your work capacity than your treating practitioner. If the insurer determines you have greater capacity to work than your certificate reflects, they can adjust or dispute your payments. This is one of the most common points at which injured workers turn to workers compensation claim lawyers.
After a defined period of weekly payments set out under the WIRC Act, stricter eligibility criteria apply. If you still have no current work capacity, payments may continue under a revised test. If the insurer finds that you do have some work capacity, payments can be significantly reduced or ceased. We explain what this means for your specific circumstances when it becomes relevant.
Two separate longer-term pathways exist beyond your weekly entitlements.
An impairment benefit is a lump sum payment available if your injury results in a permanent whole person impairment that meets the qualifying threshold under the Acts. Assessment is conducted by an independent medical assessor under a structured process. It is a no-fault benefit. Employer negligence is not required.
A common law claim is a separate claim for damages, available where employer negligence caused or contributed to your injury. Common law damages can cover pain and suffering and economic loss beyond what the no-fault scheme provides. The pathway involves establishing negligence and meeting an impairment threshold. If your injury is serious or permanent, it is worth understanding whether this pathway is open to you.
Both can sometimes be pursued alongside your ongoing entitlements. We advise on each when we assess the file.
We have run many workers compensation claims where the difficulty arose after approval, not before. One client came to us after his WorkCover claim was accepted, but his weekly payments were stopped following an Independent Medical Examination arranged by the insurer. The insurer’s doctor assessed him as having full capacity to return to work. His treating specialist disagreed significantly.
We ran a dispute through the appropriate process, supported by his specialist’s evidence and detailed clinical records. The matter resolved in his favour. He received back-payment for the period his payments were withheld during the dispute.
The point is not the result. It is that a claim being approved is not the same as having your entitlements protected. The insurer has its own interests, and what they say about your work capacity is not always the final word.
You speak direct to your lawyer. The person handling your matter is the person on the call.
We act on a no win, no fee basis. You pay nothing unless we win.
If you want a straight answer on where your matter sits and what comes next, call us. The first conversation is obligation free. Call 1300 FEARLESS (1300 332 753) or use the form on this page.
What is a workers compensation claim? A workers compensation claim is a formal application to receive compensation for an injury or illness caused by your work or workplace. Claiming workers compensation in Victoria is managed through the WorkCover scheme by authorised insurer agents. If accepted, you may be entitled to weekly payments, medical expenses, and other support during your recovery.
How do I file a workers compensation claim in Victoria? In Victoria, you complete a workers compensation claim form and attach a Certificate of Capacity from your treating practitioner. The form is submitted to your employer, who is required to forward it to their insurer within the timeframe set out under the WIRC Act. We can assist with the lodgement process and make sure the right information is included from the start.
How do I make a workers compensation claim? Contact your treating doctor first. They will provide the Certificate of Capacity that supports your claim. From there, we can walk you through the workers compensation claim form, the submission process, and what to include to give your claim the strongest foundation.
How long after an injury can I claim workers compensation? In Victoria, claiming workers compensation should happen as soon as possible after the injury occurs. Late claims can be accepted in some circumstances, but delay creates complications and can weaken your position. If you are unsure whether it is too late to lodge a claim, speak to us directly.
How do I check the status of my workers compensation claim? Your insurer must notify you of their decision within the timeframe prescribed by legislation. If you have not heard back, contact your insurer in the first instance. We can also make enquiries on your behalf.
Can an approved claim be reversed or cancelled? Yes. An accepted claim can be reviewed and entitlements reduced or stopped if the insurer forms the view that circumstances have changed. For example, that your work capacity has improved or that your injury is no longer connected to your employment. If this happens, you have rights to dispute the decision, and strict time limits apply.
How long does workers compensation last after approval? Weekly payments can continue for a defined period while you have no or limited work capacity. After that period, stricter criteria apply. How long payments continue depends on your capacity, the medical evidence, and how the insurer assesses your ongoing entitlements. There is no single answer that applies to every claim.
How soon do weekly payments start after approval? Weekly payments are generally backdated to your date of incapacity once the claim is approved. Processing times vary by insurer. If there is a delay in your first payment, follow it up with the insurer in writing, and keep a record of the exchange.
Michael Tanner is the founder and principal at National Compensation Lawyers, leading the firm’s WorkCover practice across Melbourne and regional Victoria.