Specialist expertise in the Comcare sector
We are the largest workers compensation claims manager in the scheme outside of Comcare. We provide a streamlined solution for potential or current self-insured employers within the Comcare scheme.
We have extensive industry knowledge as claims manager for several self-insured Comcare licensees and has used this expertise to provide workers compensation guidance to a selection of premium paying agencies.
We draw on more than a century of experience in workplace injury management, people management, strategy and technology skills helping thousands of workers recover from injury and return to work.
Make a claim
To start the claims process, choose your scheme from the choices below.
| Contact/Email address | Fax/Toll free | Postal |
|---|---|---|
| Medibank medibankselfinsurance@eml.com.au |
02 8251 9495 1800 571 925 |
GPO Box 4580 Sydney NSW 2001 |
| Pacific National PN@eml.com.au |
02 6160 1698 1800 469 931 |
GPO Box 805 Canberra ACT 2601 |
| ACT Government ACTG@eml.com.au |
02 6160 1698 1800 365 227 |
GPO Box 805 Canberra ACT 2601 |
Frequently Asked Questions
What is workers’ compensation?
Workers’ compensation is a form of insurance payment to employees if they are injured at work or become sick due to their work.
Workers’ compensation includes:
- payments to employees to cover their wages while they're not fit for work;
- medical expenses;
- and rehabilitation.
Who can claim workers’ compensation?
If you are an employee and you have sustained an injury or illness due to your work or during your work, you may be entitled to a range of benefits and compensation.
What are the first steps if I am injured at work?
Do I need a medical certificate from an allied health provider?
You do not need a medical certificate from a legally qualified medical practitioner (LQMP) if you are only claiming for medical treatment by an allied health practitioner, such as a registered chiropractor, osteopath, physiotherapist, or masseur. A certificate from your treatment provider is sufficient.
If you wish to claim other benefits, such as incapacity payments or permanent impairment, you will need to provide appropriate medical evidence from an LQMP.
How can I contact my Case Manager?
You can contact your Case Manager via their direct phone number, direct email address, or via 1800 365 227 or 1800 571 925.
If your Case Manager is on planned leave, you will receive an out of office email which will provide you with an alternative contact.
If your Case Manager is on unplanned leave, your phone call will be directed to an alternate Case Manager who will be able to assist you with your query. If the matter is not urgent, your Case Manager will return your call when they return from leave.
What should I do if I need urgent treatment?
Before treatment is approved, we require enough medical information to relate the treatment to your compensable condition. If you are unable to get this information to us before undertaking the treatment, please contact your Case Manager to discuss your options.
Are there time limits to lodge a workers’ compensation claim?
There are no specific time limits, however if you sustained a work-related injury or illness, and you intend to submit a claim for workers compensation, you are obligated to provide written notice of your claim as soon as practicable after first becoming aware of the injury. Completing and submitting a claim form is considered to be written confirmation.
How will we assess whether your claim will be accepted?
When you lodge a claim for a work-related injury or illness, your Case Manager will review the information you have provided, along with information from your employer, and your medical practitioner.
For compensation to be payable under the SRC Act, we must determine liability for a claim exists.
Determining that liability exists is confirmation that:
- you have a medical condition; and
- that medical condition was caused by, or contributed to, by your work.
How long will it take to assess whether my claim will be accepted?
We will provide you with a written response to your claim as soon as possible. In some cases, we can issue a decision within 5 days of receipt of your claim. More complex cases can take longer (up to 60 days) depending on whether we need more information to assess your claim.
What benefits and compensation can I receive?
Under the SRC Act, injured employees have two separate sets of rights and entitlements, these are:
- no-fault benefits; and
- a Common Law damages claim against the at fault party.
Under the no fault scheme, if your workers’ compensation claim is accepted, you may be eligible for support and financial assistance, such as:
When pursuing a claim for permanent injuries, injured employees are required to establish a greater than 10% impairment when assessed in accordance with the relevant guides before compensation will be awarded.
How are claims for medical treatment assessed?
After receiving a claim for workers’ compensation, we will consider the following information when assessing what benefits are reasonable for your injury:
- Does the treatment constitute medical treatment as defined by the SRC Act?
- Is the treatment reasonable in the circumstances?
- Is the treatment related to your compensable condition?
What should I do if I need time off work as a result of my injuries?
What if I have used personal leave or annual leave while waiting for my claim to be accepted?
If you have accessed personal or annual leave in relation to your accepted claim and compensable condition, your employer will reimburse your leave.
What are my options if I disagree with a decision you make on my claim?
Most decisions made by us are called determinations. If you disagree with the determination made, you can request an independent review, in writing. This must be made within 30 days.
The reconsideration is completed by our Reconsiderations Officer, who is independent to the determination. A written decision called a reviewable decision will be issued, usually within 20 days.
If you disagree with any part of that reviewable decision, you can then lodge an appeal to the Administrative Appeals Tribunal. This must be lodged within 60 days. More information can be found on the AAT website.
How can I access my claim records?
If you would like copies of documents held on your claim file held by us, you can write to us asking for the documents you need.
We are not able to release some documents. Please contact your Case Manager if you would like some more information about this.
What are our privacy obligations?
Our privacy policy can be found here.
There is also information within the claim form about our obligations specific to the collection, use and disclosure of an injured employee’s health records and other personal information.
What is the purpose of an Independent Medical Examination?
Your Case Manager will discuss with you the reasons why an Independent Medical Examination has been scheduled. Some of the reasons for an appointment to be scheduled include, but are not limited to:
- To assist in making a liability determination on your claim.
- To assist in reviewing your ongoing treatment requirements.
- To assist in reviewing a request for surgery.
Further information regarding Independent Medical Examinations can be found here.
What are my roles and responsibilities through the claims process?
Your role:
- Co-operate with your employer, Case Manager, Rehabilitation Case Manager and rehabilitation provider, to remain at work, or to return to work if you have required time off.
Your responsibilities:
- Provide us with timely, accurate and complete information about your claim.
- Advise us as soon as possible of any changes in your circumstances.
- Actively participate in your rehabilitation program.
- Communicate regularly with your Case Manager.
What are my employer’s roles and responsibilities through the
claims process?
Employer’s roles:
- Assess your needs and assist you by providing appropriate support and assistance.
- Support you to remain at work, or to return to work if you have had time off.
Employer’s responsibilities:
- Make any reasonably practicable changes to your workplace to reduce the chance of further injury
- Provide a Rehabilitation Case Manager to support you
- Provide you with accurate, timely and complete information about your rehabilitation
- Foster a workplace that encourages and supports safe work practices.
- Identify suitable duties with your Rehabilitation Case Manager while continuing to support you.
What is our role and responsibilities through the claims process?
Our role:
- Work with you and your employer to assist you in remaining at work or returning to work.
Our responsibilities:
- Make accurate and timely decisions.
- Provide you and your employer with information to minimise effects of any workplace injury or illness
- Provide you with clear reasons for decisions made on your claim.
- Adhere to agreed service standards
- Be courteous and fair
- Keep you informed about the progress of your claim and of the any reasons for any delay
- Make it easy for you to communicate with us