Am I eligible to make a claim?
Before starting the claims process, it is a good idea to find out whether you are covered by the Comcare scheme, and what types of claims are likely to be paid.
- Who is eligible to claim?
- Who determines my claim?
- For what can I claim?
- What claims could be excluded?
Who is eligible to claim?
You should talk to your employer about whether the terms of your employment mean that you would be covered under the scheme. Your employer should provide you with a claim form.
The Comcare scheme covers employees of:
- Commonwealth Government agencies and statutory authorities (but excluding members of the Australian Defence Force)
- ACT Government and its agencies
- Corporations who have been granted a licence to self insure, provided the date of injury was after the date of the licence. (View list of licensees.)
Who determines my claim?
The ‘determining authority’ is the organisation responsible for making a decision on your claim.
Employees of: | Who determines my claim? |
| Commonwealth Government agencies and statutory authorities | Comcare |
| ACT Government and its agencies | Comcare |
| Licensees | The employer, or through it a designated claims agent |
Lodging a claim
A medical certificate must be attached to your claim form when it is lodged. It is preferable that claims be lodged through your employer - to enable your employer to complete its part of the claim form - but there is no legal requirement to do so. A claim can be lodged directly with the determining authority.
Getting a decision
The determining authority will provide you with its decision in writing, explaining the reasons for the decision and information on what to do if you are not satisfied with the decision.
If you have a complaint about the process for lodging a claim or the way your claim has been managed, please call Comcare on 1300 366 979.
For what can I claim?
You can claim compensation if you consider you were injured in the course of your employment, for example:
- you were at work (including during an ordinary recess while at your place of work)
- you were working or on work-related business elsewhere
- you were travelling for work or work-related business
You can also claim compensation for an illness (disease) if you consider your employment caused or contributed to the illness or aggravated the illness. However, your employment must have caused or contributed to your illness to a significant degree for your claim to be accepted. Some employment contributions are excluded.
What claims could be excluded?
The SRC Act excludes any:
- disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner by an employer. Reasonable administrative action includes (but is not limited to):
- reasonable appraisal of performance
- a reasonable counselling action (whether formal or informal)
- a reasonable suspension action
- a reasonable disciplinary action - disease, or aggravation suffered as a result of failure to obtain a promotion, reclassification, transfer or benefit, or to retain a benefit in connection with work
- injury that is intentionally self-inflicted
- injury that is caused by serious and wilful misconduct (except where the injury results in death or serious and permanent impairment)
- injury whilst travelling between home and usual place of work
- injury that occurs while away from the workplace during a recess break (e.g. lunch)
Note: a person who is under the influence of alcohol or a drug, other than a prescribed drug correctly taken, “shall be taken to be guilty of serious and wilful misconduct”.)
The information above is provided as a guide only and the final decision on any claim you lodge will be made by the relevant determining authority.