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EMPLOYMENT LAW GUIDES

Workers' compensation in Victoria: how WorkCover works and how to make a claim

A simple, practical guide for workers and small business owners

Updated 21 Jan 2026 Victoria only Scheme administered by WorkSafe Victoria

Steve Harris

Written by

Steve Harris

Steve Harris Steve has been part of the RosterElf team since 2017, contributing content on workplace management, payroll compliance, and employee scheduling best practices.

This guide provides general information about workers' compensation in Victoria as at the date of publication, drawing on official sources like WorkSafe Victoria and the Workplace Injury Commission.

It is not legal, medical, or financial advice and shouldn't be relied on as a substitute for advice tailored to your situation. Every WorkCover claim is different, and specific circumstances can affect entitlements.

No liability: RosterElf Pty Ltd, its directors, employees, and authors expressly disclaim any and all liability for any loss, damage, cost, or expense (whether direct, indirect, consequential, or otherwise) arising from or in connection with reliance on the information in this guide.

If you need help with a WorkCover claim, contact WorkSafe Victoria or seek advice from a workers' compensation lawyer.

Quick summary for time-poor readers

If you only read one section, read this:

  • WorkCover is Victoria's workers' compensation scheme, administered by WorkSafe Victoria.
  • It covers employees who suffer work-related injuries or illnesses, including mental injuries (with specific criteria).
  • Benefits include weekly payments (income support), treatment expenses, and permanent impairment benefits.
  • You should notify your employer within 30 days of the injury. The WorkSafe agent has 28 days to make a decision.
  • Weekly payments are calculated using your PIAWE (Pre-Injury Average Weekly Earnings): 95% for the first 13 weeks, then 80% from weeks 14-130. Maximum payment is $2,930/week (as at 1 July 2025).
  • Employers must provide suitable employment for the first 52 weeks (return to work obligation).
  • If your claim is rejected, you can request conciliation at the Workplace Injury Commission within 60 days.
1

30 days

Recommended timeframe to notify employer of injury in writing

2

28 days

WorkSafe agent must make claim decision within this window

3

95% of PIAWE

Weekly payment rate for first 13 weeks (no capacity)

4

80% of PIAWE

Weekly payment rate from weeks 14-130 (no capacity)

5

$2,930/week

Statutory maximum weekly payment (as at 1 July 2025)

6

52 weeks

Employer return to work obligation period (suitable employment)


What is WorkCover?

WorkCover is Victoria's workers' compensation scheme. It's established under the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic), commonly called the WIRC Act.

WorkSafe Victoria is the government body that administers the scheme and regulates workplace health and safety in Victoria. Other states have different systems—see our guide for SA workers' compensation.

How WorkCover works: three key parties

1. The worker (employee)

The person who suffered a work-related injury or illness and lodges the WorkCover claim.

2. The employer

Must hold WorkCover insurance, report injuries, forward claim documentation to the WorkSafe agent, and provide suitable employment during return to work.

3. The WorkSafe agent

An insurance company appointed by WorkSafe to assess claims, make decisions on liability, arrange payments, and manage return to work. Examples include Allianz, EML, Gallagher Bassett, and DXC.

Who WorkCover covers

WorkCover covers workers (employees) who are employed in Victoria and suffer a work-related injury or illness.

Covered workers

  • Full-time, part-time, and casual employees
  • Workers on fixed-term contracts
  • Apprentices and trainees
  • Labour hire workers (covered by the host employer's policy in some cases)
  • Some deemed workers (specified in legislation)

Who's NOT covered

Contractors vs employees

Independent contractors are generally not covered by WorkCover. The distinction between employee and contractor depends on factors like control, equipment, financial risk, and the contract structure. If there's a dispute, the WorkSafe agent will assess the relationship.

  • Independent contractors (unless deemed workers under specific provisions)
  • Volunteers (unless specifically covered)
  • Self-employed sole traders
  • Employers (unless they opt-in for personal cover)

What WorkCover covers

WorkCover provides a range of benefits to workers with accepted claims:

1. Weekly payments (income support)

If you have no capacity or reduced capacity for work due to your injury, you may receive weekly payments calculated as a percentage of your Pre-Injury Average Weekly Earnings (PIAWE):

  • First 13 weeks: 95% of PIAWE (no capacity) or 95% minus current earnings (reduced capacity)
  • Weeks 14-130: 80% of PIAWE (no capacity) or 80% PIAWE minus 80% of current earnings (reduced capacity)
  • After 130 weeks: Eligibility thresholds apply (no current work capacity and unlikely to return to work)

Maximum weekly payment: $2,930/week (as at 1 July 2025, indexed annually).

2. Treatment expenses

WorkCover pays the reasonable cost of medical treatment related to your work injury, including:

  • GP visits and specialist consultations
  • Hospital treatment and surgery
  • Physiotherapy, occupational therapy, and other allied health services
  • Prescription medications
  • Medical aids and equipment (e.g., crutches, braces)
  • Travel to medical appointments (reasonable transport costs)

Gap fees

If your treating practitioner charges more than the scheduled fee, you may need to pay the "gap" yourself. Always check fee arrangements before proceeding with treatment.

3. Provisional payments (mental injury claims)

For mental injury claims, you may receive up to 13 weeks of provisional weekly payments and treatment support while your claim is being assessed. This allows early intervention before a liability decision is made.

4. Permanent impairment benefits

If your injury results in permanent impairment, you may be entitled to:

  • Lump sum compensation (impairment benefit) based on the degree of impairment assessed by an Independent Impairment Assessor
  • Pain and suffering damages (if impairment is greater than 30%)

5. Superannuation payments

After receiving weekly payments for 52 weeks, the WorkSafe agent must pay superannuation contributions on your behalf.

6. Death benefits

If a worker dies as a result of a work injury, dependants may be entitled to weekly payments and lump sum death benefits.

7. Common law damages

In limited circumstances, workers may be able to pursue common law damages (a court claim for compensation) if they meet the serious injury threshold and can prove negligence. This is a complex legal process and requires advice from a workers' compensation lawyer.


How to make a WorkCover claim: step-by-step

Follow these steps to lodge a WorkCover claim in Victoria:

Step 1: Get medical help and document the injury

Seek medical treatment immediately. Document what happened, when, where, and how the injury occurred. Take photos if relevant. Keep all medical records and receipts.

Step 2: Notify your employer in writing (within 30 days)

Report the injury to your employer in writing as soon as possible, ideally within 30 days of the injury or becoming aware of it. Use email, letter, or incident report form. Keep a copy.

Step 3: Employer records in workplace injury register

Your employer must record the injury in their workplace injury register within 48 hours. Confirm this has been done.

Step 4: Get a certificate of capacity (if claiming weekly payments)

If you are claiming weekly payments, you need a Certificate of Capacity from your doctor stating you have no capacity or reduced capacity for work. Your doctor will specify the period covered and any work restrictions.

Step 5: Complete the Worker's injury claim form

Complete the official Worker's injury claim form with all required information: personal details, employer details, injury details, medical treatment, and employment history. Your employer should provide this form.

Step 6: Submit to your employer

Submit the completed claim form and Certificate of Capacity to your employer. Keep copies of everything you submit.

Step 7: Employer forwards to WorkSafe agent (strict deadlines)

Your employer must forward the claim to their WorkSafe agent within strict deadlines:

  • Mental injury: Early notification within 3 business days, full documentation within 10 calendar days
  • Physical injury: Full documentation within 10 calendar days

Step 8: Agent assesses claim (28 days)

The WorkSafe agent must make a decision within 28 days of receiving all required information. They will contact you if they need more information or documentation.

What happens next?

Once your claim is accepted:

  • Your employer will pay your weekly payments (if entitled) and claim reimbursement from the agent
  • Treatment providers will bill the agent directly (or you can claim reimbursement for paid expenses)
  • You must provide updated Certificates of Capacity regularly (typically every 1-4 weeks)
  • Your employer and the agent will work with you on return to work planning

WorkCover claim readiness checklist

Use this checklist to ensure you have everything ready before lodging your WorkCover claim:


Weekly payments & PIAWE

What is PIAWE?

PIAWE stands for Pre-Injury Average Weekly Earnings. It's the calculation of your average weekly earnings before your injury, including:

  • Base salary or wages
  • Shift allowances (e.g., night shift, weekend penalties)
  • Regular overtime (worked in the normal course of employment)
  • Commission and bonuses (if regular and predictable)

PIAWE generally excludes:

  • Irregular overtime
  • One-off bonuses
  • Allowances not related to work performed (e.g., tool allowance)

How weekly payments are calculated

Your weekly payment depends on your capacity for work and how long you've been receiving payments:

Period No capacity for work Reduced capacity for work
First 13 weeks 95% of PIAWE (95% × PIAWE) - current earnings
Weeks 14-130 80% of PIAWE (80% × PIAWE) - (80% × current earnings)
After 130 weeks Eligibility thresholds apply: No current work capacity AND unlikely to return to work

Statutory maximum weekly payment

The maximum weekly payment is $2,930 per week (as at 1 July 2025). This amount is indexed annually on 1 July. Even if your PIAWE is higher, your payments are capped at this maximum.

Example: First 13 weeks calculation

Alex has a PIAWE of $1,200/week. For the first 13 weeks with no capacity for work, Alex receives: $1,200 × 95% = $1,140/week. If Alex has reduced capacity and earns $400/week in suitable duties, Alex receives: ($1,200 × 95%) - $400 = $740/week.

How overtime and shift allowances are included

Regular overtime and shift allowances that are part of your normal work pattern are included in PIAWE. The WorkSafe agent will look at your work history over the 52 weeks before injury to determine what's "regular."

Treatment expenses

WorkCover covers the reasonable cost of medical treatment related to your work injury, including:

  • General practitioner and specialist consultations
  • Hospital treatment and surgery
  • Physiotherapy, occupational therapy, psychology, and other allied health
  • Prescription medications
  • Medical aids and equipment (crutches, braces, orthotics)
  • Travel to medical appointments (reasonable transport)

Gap fees warning

Watch out for gap fees

WorkSafe Victoria publishes a schedule of fees for medical services. If your treating practitioner charges more than the scheduled fee, you may be responsible for the "gap." Always confirm fees before proceeding with treatment.

How to claim reimbursement

  • Most treatment providers will bill the WorkSafe agent directly (no upfront payment needed).
  • If you pay for treatment yourself, submit receipts to the agent for reimbursement.
  • Reimbursement must be paid within 30 days of the agent receiving your receipt.
  • Receipts must be submitted within 6 months of the treatment.

Mental injury claims

WorkCover can cover mental injuries (sometimes called psychological injuries) if they are caused by work. Mental injury claims have specific eligibility criteria and processes.

Provisional payments (up to 13 weeks)

For mental injury claims, you may be eligible for up to 13 weeks of provisional weekly payments and treatment while your claim is being assessed. This allows early access to support and treatment before a liability decision is made.

Eligibility criteria for mental injury claims

To be eligible, your mental injury must:

  • Be caused by your employment (work must be a significant contributing factor)
  • Be diagnosed as a mental injury by a qualified psychiatrist or psychologist
  • Meet the DSM diagnostic criteria

Important exclusions

Reasonable management action exclusion

Mental injury claims are generally excluded if the injury was wholly or predominantly caused by reasonable management action taken in a reasonable manner. This includes performance management, disciplinary action, and lawful termination.

Other exclusions include mental injury wholly or predominantly caused by:

  • Reasonable management action taken in a reasonable manner
  • Your own expectations about promotion, transfer, or advancement
  • Workplace changes made as a result of business decisions

DSM diagnosis requirement

Your doctor must provide a Certificate of Capacity with a DSM diagnosis (Diagnostic and Statistical Manual of Mental Disorders) for the mental injury. This is a requirement introduced from 31 March 2024.

Changes from 31 March 2024

From 31 March 2024, new requirements apply to mental injury claims, including DSM diagnoses on Certificates of Capacity and revised provisional payment rules. Check WorkSafe Victoria for the latest information.

Permanent impairment and damages

Lump sum impairment benefits

If your work injury results in permanent impairment, you may be entitled to a lump sum impairment benefit. The amount depends on:

  • The degree of impairment (assessed using the WorkSafe Impairment Guide)
  • Your age at the time of assessment
  • The nature and severity of the injury

When can you claim?

You can claim a lump sum impairment benefit when your injury has stabilised. This typically means:

  • You've had maximum medical improvement (no further significant improvement expected)
  • Your condition is unlikely to change substantially in the next 12 months
  • Often requires 12+ months since injury

Independent impairment assessor process

Your permanent impairment is assessed by an Independent Impairment Assessor appointed by WorkSafe. The assessor uses the WorkSafe Impairment Guide to rate your impairment as a percentage. The assessment is binding.

Common law damages

In limited circumstances, if you have a serious injury (generally whole person impairment greater than 30%), you may be able to pursue common law damages through the courts. This is a complex legal process requiring proof of negligence.

Seek legal advice

Common law damages claims have strict time limits and complex legal requirements. If you think you may have a serious injury, speak to a workers' compensation lawyer as soon as possible.

Return to work obligations

Employer's 52-week suitable employment obligation

If you have an accepted WorkCover claim and have capacity for suitable employment, your employer has a legal obligation to provide you with suitable employment for the first 52 weeks after your "capacity date" (the date your certificate says you have capacity for some work).

This obligation applies even if suitable duties weren't available at the time of injury.

When does the obligation start?

The 52-week obligation starts from the capacity date — the date your Certificate of Capacity states you have capacity for some work (even if it's reduced capacity).

What is "suitable employment"?

Suitable employment means work that:

  • Is safe and appropriate given your injury and medical restrictions
  • Provides you with earnings comparable to your pre-injury earnings where reasonably practicable
  • Is within your skills, training, and experience
  • Takes into account your age, education, and training

What if the employer can't provide suitable employment?

If the employer genuinely can't provide suitable employment, they may be required to:

  • Provide evidence of why suitable employment isn't available
  • Assist you in finding suitable employment with a new employer
  • Continue weekly payments if you have no capacity for available work

Return to work coordinator

Employers with 30 or more employees must appoint a Return to Work Coordinator (RTWC) to manage return to work processes. The RTWC is responsible for coordinating return to work plans and liaising with the worker, doctor, and WorkSafe agent. Managing modified work schedules and light duties requires careful planning to meet both operational needs and medical restrictions.


Employer compliance checklist

If you're an employer, here are the key WorkCover compliance obligations:

1

Register for WorkCover insurance (within 60 days)

All Victorian employers must register for WorkCover insurance with WorkSafe Victoria within 60 days of employing their first worker. This is mandatory even if you have only one employee.

2

Keep a register of workplace injuries

Record all workplace injuries in your workplace injury register within 48 hours. This includes minor injuries that don't result in WorkCover claims. Keep the register for at least 5 years. Using time and attendance tracking systems helps maintain accurate records of when injuries occur.

3

Acknowledge and process claims correctly

When an employee reports an injury, provide them with a Worker's injury claim form and explain the claims process. Handle claims sensitively and professionally.

4

Submit claims within deadlines

Forward completed claims to your WorkSafe agent within strict deadlines:

  • Mental injury: Early notification within 3 business days, full documentation within 10 calendar days
  • Physical injury: Full documentation within 10 calendar days
5

Understand employer excess

You pay the employer excess before WorkCover benefits begin:

  • First 10 days of weekly payments
  • $876 medical excess for physical-only injury claims (2025/26)
Mental injury claims have different arrangements.
6

Maintain return to work records

Keep return to work plans, Certificates of Capacity, and all communication with the WorkSafe agent. Appoint a Return to Work Coordinator if you have 30+ employees.

7

Report notifiable incidents separately

Serious incidents (fatalities, serious injuries requiring immediate hospital treatment, dangerous occurrences) must be reported to WorkSafe Victoria immediately by phone, then in writing within 48 hours. This is separate from the WorkCover claim process.

WorkSafe agents

What is a WorkSafe agent?

A WorkSafe agent is an insurance company appointed by WorkSafe Victoria to assess and manage WorkCover claims on behalf of WorkSafe. The agent makes decisions about claim liability, arranges payments, and manages return to work.

Current WorkSafe agents (as at 2026)

The current WorkSafe agents are:

  • Allianz Australia Insurance Limited
  • Employers Mutual Limited (EML)
  • Gallagher Bassett Services Pty Ltd
  • DXC Technology Australia Pty Ltd

Your employer's WorkCover policy is underwritten by one of these agents. You can find agent contact details on WorkSafe Victoria's website.

When to contact the agent

Contact your WorkSafe agent if you need to:

  • Check the status of your claim
  • Submit updated Certificates of Capacity
  • Claim reimbursement for medical expenses
  • Discuss return to work arrangements
  • Request an internal review of a decision

Disputes and reviews

If your WorkCover claim is rejected or you disagree with a decision, you have several options:

1. Internal review (agent reconsideration)

As a first step, you can request the WorkSafe agent to reconsider their decision. Provide any new information or evidence that supports your claim. This is often the quickest way to resolve a dispute.

2. Conciliation (Workplace injury Commission)

You can apply for conciliation at the Workplace Injury Commission (WIC) within 60 days of the decision. Conciliation is:

  • Free
  • Conducted by a conciliator (magistrate or lawyer)
  • An opportunity for parties to reach an agreement
  • Less formal than court proceedings

Most disputes are resolved at conciliation.

3. WorkCover independent review service (WCIRS)

For certain decisions (medical treatment, permanent impairment assessments, return to work capacity), you can request a review by WCIRS. You must apply:

  • Within 6 months of becoming aware of the decision, OR
  • Within 30 days of receiving a Genuine Dispute Outcome Certificate from conciliation

WCIRS provides independent expert opinions and is binding.

4. Arbitration (Workplace injury Commission)

If conciliation doesn't resolve the dispute, you can proceed to arbitration at the Workplace Injury Commission. Arbitration is more formal than conciliation and involves presenting evidence and legal arguments. The arbitrator's decision is binding.

Practical tip: Act quickly

Time limits for disputes are strict. If your claim is rejected, get advice early and lodge any applications within the required timeframes. Missing a deadline can mean you lose your right to dispute the decision.

Special note: Silica-related illness support

If you are a stonemason, benchtop manufacturer, or worker exposed to silica dust and have been diagnosed with a silica-related illness (silicosis, lung disease), WorkSafe Victoria has dedicated support pathways. Contact the WorkSafe Silica Advisory Service for specialist advice on claims and support.


Common mistakes that cause problems

For workers:

Not reporting the injury in time or not reporting it in writing (always use email or a formal report form)

Not getting a Certificate of Capacity from your doctor (required if claiming weekly payments)

Paying for treatment yourself and then losing receipts (submit receipts within 6 months)

Assuming stress or burnout is automatically covered (mental injury claims have specific eligibility criteria and exclusions)

For employers:

Missing claim forwarding deadlines to the WorkSafe agent (3 days early notification for mental injury, 10 days for documentation)

Not maintaining a workplace injury register or keeping poor records (register required within 48 hours, kept for 5+ years)

Misunderstanding employer excess (you pay first 10 days of weekly payments + $876 medical excess for physical-only claims)

Treating return to work as optional (you have a legal obligation to provide suitable employment for 52 weeks)


Official victorian resources

Key government resources for Victorian workers' compensation:


Sources and references

Primary sources used for this guide:

This guide was last updated on 21 January 2026. WorkCover rates and thresholds are indexed annually on 1 July. Always check WorkSafe Victoria for the latest rates and information.

FAQ

Frequently asked questions

  • You should notify your employer within 30 days of the injury or becoming aware of it. While this is the recommended timeframe, you can still make a claim after 30 days, but delays may complicate your claim.
  • Yes. If you are claiming weekly payments, you need a Certificate of Capacity from your doctor stating you have no capacity or reduced capacity for work. This certificate must be renewed regularly (typically every 1-4 weeks depending on the stage of your claim).
  • It depends on whether you're classified as an employee or independent contractor. WorkCover covers workers (employees), not independent contractors. If there's a dispute about your status, the WorkSafe agent will assess factors like control, equipment, and financial risk.
  • You can still make a claim, but you should provide a reasonable explanation for the delay. The agent will consider factors like medical advice, communication difficulties, or other valid reasons when assessing your claim.
  • Yes. You have the right to choose your own treating doctor (GP or specialist). Your doctor will provide Certificates of Capacity and treatment plans. The WorkSafe agent may request independent medical examinations, but your own doctor remains your primary treating practitioner.

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