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What Doesn't WorkCover Cover?

workers compensation lawyers

Queensland’s workers' compensation insurance scheme is called WorkCover. 

WorkCover exists to assist those who have been injured at work or because of work by providing payments for both statutory (no-fault) claims, where successful claimants are paid compensation no matter who was at fault, and for claims initiated by the worker against their employer (which is also known as ‘suing’).

The types of payments WorkCover will make to an eligible worker may be used to cover:

  • lost wages (much like a weekly income);
  • lump-sum payments for permanent impairment;
  • medical treatments and rehabilitation;
  • travel and associated allowances;
  • return to work support; and
  • death benefits and funeral expenses.

So, what won’t WorkCover pay for when an employee makes a successful claim for workers compensation?

Injuries sustained while not at work

As WorkCover is only to help those who have been injured at work, any injuries suffered outside the workplace won’t be covered. If you have been injured outside of work hours you may be able to make a personal injury claim against the negligent party or a public liability claim if the accident occurred in a public place.

Injuries that have been sustained on a worksite (as opposed to your usual office), while travelling to and from work, while on a work trip or while working from home may be covered and will be assessed under the same guidelines as an injury sustained at the employee’s main place of work.

Un-approved hospital expenses

Elective hospitalisation may not be covered by WorkCover unless it has been pre-approved. The term ‘elective hospitalisation’ covers any treatment or procedure that you and your medical practitioner have decided you should have to assist with your condition, but that is not necessarily for life-threatening or serious injuries.

Non-elective hospitalisation refers to treatments or procedures that are essential to your care. It is important that you always have confirmation from WorkCover that they will cover any hospital stays, even if they are non-elective.

Home Help

WorkCover will not reimburse workers for the cost of home help such as cleaning and gardening, however, if you receive a lump sum settlement as part of your claim, you may be able to factor in any costs you have already incurred in paying for assistance or that you expect to spend on receiving this type of domestic help in the future because you are not able to do it yourself

Some Travel Expenses

WorkCover will cover certain travel expenses when a claimant needs to attend medical appointments that are more than 20km away (each way). When travelling to these appointments, WorkCover may also reimburse the worker for meals, medication and parking expenses.

If a medical appointment is less than 20km away WorkCover will not cover the worker’s expenses incurred to attend the appointment.

WorkCover also does not cover travel expenses in cases where the worker is able to see a medical provider near to where they live but the worker instead chooses to travel farther away to see a different, comparable provider.

Alternative Medical Treatments

WorkCover will not cover alternative medical treatments with the exception of massage or acupuncture, so long as it is performed by a physiotherapist or registered Chinese Medicine practitioner. You should always confirm with WorkCover prior to having this type of treatment to ensure you will be reimbursed for its cost.

When you have sustained an injury and are working reduced hours or not at all, regaining your health is usually at the forefront of your mind. Having to navigate the workers' compensation claim process can cause added and unnecessary stress. If you are planning on making a workers compensation claim our workers' compensation lawyers can assist you with navigating the process from start to finish.

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