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- Roles and responsibilities - claims
- Can I claim?
- Lodging a claim
- Assessing a claim
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Can I claim?
Am I eligible to make a claim?
The Comcare scheme covers employees of:
- Commonwealth Government agencies and statutory authorities (excluding serving members of the Australian Defence Force with injuries sustained after 1 July 2004)
- ACT Government
- Corporations or authorities who have been granted a license to self-insure, called 'licensees'.
Your employer will be able to advise you whether you are covered by the Comcare scheme or you can contact Comcare directly on 1300 366 979.
For information regarding claims for workers' compensation, and claims for compensation or damages, see Asbestos-related claims.
What can I claim compensation for?
You can claim compensation if you think you sustained an injury due to your work, or during your work, for example:
- you were at work (including during an ordinary recess)
- you were working or on work-related business
- you were travelling for work or work-related business.
You may also claim compensation if you consider your employment caused or contributed to a disease or aggravated a disease. For a disease claim to be accepted your employment must have significantly contributed to your disease or its aggravation.
What claims could be excluded?
The SRC Act excludes any:
- Disease, injury or aggravation claims 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
- 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 while travelling between home and usual place of work.
- Disease, where you have made a wilful and false representation that you did not or had not previously suffered from that disease, in connection with your employment or proposed employment.
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.
Who determines my claim?
The 'determining authority' is the organisation responsible for making a decision on your claim.
|For the employees of...||Their claim will be determined by...|
|Commonwealth Government agencies and statutory authorities||Comcare|
|ACT Government and its agencies||Comcare|
|Licensees||The employer or its approved claims agent|
Lodging a claim
To claim compensation from Comcare you will need to notify Comcare and your employer in writing as soon as practical after you become aware of your injury or disease. You can do this by completing a Claim for Workers' Compensation Form.
You also require a comprehensive medical certificate that includes a precise diagnosis of the condition you are claiming compensation for, cause of the condition, date of injury, fitness for work, recommended treatment and other details as listed under What information should a medical certificate include?
Submit your completed claim form and comprehensive medical certificate to your employer. This process allows your employer to complete the second half of the claim form before they submit it to Comcare and means Comcare has all the information needed to register the claim when it is received.
A claim can be lodged directly by you with Comcare. Where this occurs, Comcare will liaise with your employer to complete the second half of the claim form. If you are an employee of a licensee you will need to discuss the claim submission process directly with your employer.
For more information on lodging a claim with Comcare see Lodging a claim.
Getting a decision
After your claim has been determined, Comcare or the licensee or its claims agent, will provide you with its decision in writing. The written determination will explain the reasons for the decision and provide you with 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.