Claims and rehabilitation forms

• Aids and Appliances (Excluding Hearing Aids) Claim form (PDF 75.4 KB)
• Alterations to a Place of Residence or Work or Modifications to a Vehicle or Article Claim form (PDF 114.5 KB)
• Authority (or Removal of Authority) to Act on Employee's Behalf form (PDF 67.8 KB)
• Authority and Consent for the Collection and Release of Medical Information Pertaining to my Claim form (PDF 101.6 KB)
• Authority and Consent for the Collection and Release of Medical Information Pertaining to my Claim sample form (PDF 106.9 KB)
• Authority and Consent for the Release of Superannuation Information form (PDF 66.3 KB)
• Case Conference (Multiple Claims) Request form (PDF 61.2 KB)
• Case Conference (Single Claim) Request form (PDF 91.9 KB)
• Certificate of Capacity - Use in Best Practice (Bp Premier) guide (PDF 542.2 KB)
• Certificate of Capacity - Use in Genie guide (PDF 81.7 KB)
• Certificate of Capacity - Use in Medical Director guide (PDF 383.9 KB)
• Certificate of Capacity form (PDF 418.5 KB)
• Cessation of Employment form (PDF 76.5 KB)
• Claim for Time Off Work form (PDF 64.9 KB)
• Claim for Time Off Work Online form
• Claim for Time Off Work Online form information for employees (PDF 99.3 KB)
• Claim for Time Off Work Online form information for employers (PDF 100.4 KB)
• Claim for Time Off Work Online form reference guide for employees (PDF 117.6 KB)
• Contact Us Online Enquiry form
• Customer Information System (CIS) Access Request and Rehabilitation Case Manager update form (PDF 137.3 KB)
• Customer Information System (CIS) Agency Update Forms guide (PDF 150.3 KB)
• Customer Information System (CIS) Case Manager Update form (PDF 120.7 KB)
• Customer Information System (CIS) Cost Centre Update form (PDF 118.9 KB)
• Customer Information System (CIS) Login
• Customer Information System (CIS) New Customer Creation form (PDF 96.2 KB)
• Debtor Creation form (PDF 103.1 KB)
• Direct Payments Update form (PDF 63.3 KB)
• Electronic Funds Transfer (EFT) Request form for departments and agencies (PDF 89.4 KB)
• Electronic Funds Transfer (EFT) Request form for injured workers (PDF 87.0 KB)
• Electronic Funds Transfer (EFT) Request form for providers (PDF 83.8 KB)
• Exercise as Medical Treatment Claim form (PDF 114.0 KB)
• Fraud Report Online form
• Hearing Aid Request form (PDF 114.0 KB)
• Household or Attendant Care Services application form (PDF 118.3 KB)
• Incapacity for Work and Record of Earnings (Paid Employment) Claim form (PDF 109.8 KB)
• Incapacity for Work and Record of Earnings (Self Employment) Claim form (PDF 107.8 KB)
• Information Publication Scheme Online Request form
• Journey Claim form (PDF 126.0 KB)
• Lump Sum Redemption section 137 application form (PDF 62.6 KB)
• Medical Services Claim form (PDF 95.9 KB)
• Medication Review form (PDF 67.8 KB)
• Normal Weekly Earnings Advice form (PDF 113.5 KB)
• Normal Weekly Earnings Advice online form reference guide for employers (PDF 97.5 KB)
• Online Claims Lodgement user guide for employers (PDF 114.0 KB)
• Online Forms Employer Login
• Online Forms Super User quick reference guide (PDF 99.9 KB)
• Online Forms Super User Registration form (PDF 110.4 KB)
• Online Forms Super User Registration reference guide (PDF 106.5 KB)
• Parliamentary Injury Compensation Scheme Claim form (PDF 168.5 KB)
• Pay Start Information form (PDF 73.2 KB)
• Periodic Review form (PDF 154.5 KB)
• Permanent Impairment and Non-economic Loss Compensation Claim form (PDF 141.9 KB)
• Permanent Impairment and Non-economic Loss Compensation Claim form notes to assist (PDF 128.0 KB)
• Physiotherapy Treatment notification plan (PDF 111.5 KB)
• Physiotherapy Treatment notification plan explanatory notes (PDF 64.7 KB)
• Psychology or Counselling Extended Consultation Request form (PDF 58.5 KB)
• Psychology or Counselling Treatment notification plan (PDF 128.2 KB)
• Psychology or Counselling Treatment notification plan explanatory notes (PDF 64.0 KB)
• Reasonable Adjustment Request form (PDF 1.6 MB)
• Reconsideration Request form (PDF 112.8 KB)
• Register or Update Email and Bank Details Online form for service providers
• Rehabilitation Assessment or Examination form (PDF 148.4 KB)
• Rehabilitation Assessment or Examination sample form (PDF 171.2 KB)
• Rehabilitation Program Alteration form (PDF 133.9 KB)
• Rehabilitation Program Alteration sample form (PDF 179.1 KB)
• Rehabilitation Program Closure Record form (PDF 158.6 KB)
• Rehabilitation Program Closure Record sample form (PDF 176.3 KB)
• Rehabilitation Program form (PDF 196.3 KB)
• Rehabilitation Program sample form (PDF 274.9 KB)
• Section 45 Election form - to institute an action or proceeding for damages for non-economic loss (PDF 66.1 KB)
• Statement of Financial Circumstances form (PDF 106.4 KB)
• Suitable Duties form (PDF 92.3 KB)
• Suitable Duties sample form (PDF 120.9 KB)
• Supplier Direct Credit Information form (PDF 74.9 KB)
• Update Email and Bank Details form for employees (PDF 107.4 KB)
• Update Email and Bank Details Online form for employees
• Work Trial Agreement form (PDF 87.8 KB)
• Work Trial Agreement sample form (PDF 117.8 KB)
• Work-related Death Compensation Claim form (PDF 229.0 KB)
• Work-related Death Compensation Claim information for employers (PDF 150.7 KB)
• Workers' Compensation Claim form (PDF 180.5 KB)
• Workers' Compensation Online Claim form
• Workers' Compensation Online Claim form user guide for employees (PDF 121.8 KB)
• Workplace Rehabilitation Provider Consultant Approval application form (PDF 129.2 KB)