Understanding mental injury claims

Finding out your worker is making a Work Cover claim for a mental health related injury can be challenging.

This video explains how you'll be part of the claim, what your role is and what to expect.

We'll also cover how Work Cover makes a claim decision and what we might ask of you.

Every claim is different, but all claims need to meet certain criteria to be accepted at the start.

Work Cover will look at the information we have and figure out if there are any gaps.

Next, we'll talk to your worker and sometimes their doctor to understand what caused their mental injury.

Then we'll give you a summary of the claim.

We'll ask you to respond and outline what information we need from you as their employer.

We'll usually ask you questions about your workers role and events that may have led to their mental injury.

We might also ask for relevant policy and procedure documents from your workplace.

We'll give you a time frame to provide your response, usually a few days.

It's important to stick to this time frame because legislation says we need to decide claims within 20 business days.

Sometimes there's a dispute about the circumstances around the claim or what caused your workers injury.

When this happens, it's important to be objective in your response and stick to the facts.

That's because work cover makes decisions based on the evidence.

Keep in mind, your worker will also see your response when we send it to them and ask if they want to provide further information.

We do this so that there's procedural fairness, also known as natural justice.

We'll do the same for you until we can decide if the claim is accepted.
Whatever happens, we'll let both you and your worker know about the claim decision and keep you updated along the way.

Not all claims are accepted.

Work Cover looks at every claim to decide if it fits into the rules and guidelines.

This means we can't accept claims if medical information shows the worker doesn't have an injury, even though they might feel stressed.

A doctor has said that work is not a significant contributing factor to the injury.

There is not enough information to support a worker's version of events.

There is a time limit for making a claim too, usually six months from when they first saw a doctor for the injury.

A worker is also not eligible for compensation if their injury was caused by management action if it was reasonable and carried out in a reasonable way.

This might be performance or discipline related, or include things like team changes, leave approvals or promotions.

If we accept the claim and you disagree, you can ask us to give you written reasons for our decision within 20 business days.

If you still disagree, you can ask for the decision to be reviewed independently.

Find out more by searching for independent review of insurer decisions on our website.

Work cover pays for workers to receive treatment for a mental injury before the claim is decided.

This might include sessions with a psychologist, psychiatrist or GP.

This is because recovery can start sooner when workers can access treatment early and they can get support during the decision process.

If the claim is denied, work cover won't continue to pay for the workers psychological treatment.

The worker doesn't have to pay these costs back and it won't affect your premium calculation either.

Remember, one of the most important things you can do for a worker with a mental injury is to check in to see how they're doing and if they need any support.

If there's something you're not sure about, you can give us a call.

We're here to help.

Find the details of your claim contact by logging into Work Cover Connect, our online services portal or call 1-3 hundred 362128.

If you need help in your language, call 1800 512 451 and ask for an interpreter.

Work cover pays for workers to receive treatment for a mental injury before the claim is decided.

This might include sessions with a psychologist, psychiatrist or GP.

This is because recovery can start sooner when workers can access treatment early and they can get support during the decision process.

If the claim is denied, work cover won't continue to pay for the workers psychological treatment.

The worker doesn't have to pay these costs back and it won't affect your premium calculation either.

Remember, one of the most important things you can do for a worker with a mental injury is to check in to see how they're doing and if they need any support.

If there's something you're not sure about, you can give us a call.

We're here to help.

Find more information about how workers can access early treatment to support their recovery from a mental injury at worksafe.qld.gov.au/mentalinjury.

If you need help in your language, call 1800 512 451 and ask for an interpreter.

Helping your worker to get back to work after a mental injury is an important part of their recovery.

It can help them to get better sooner, keeps them connected to the workplace, and boosts morale.

Tasks your worker can do while they're recovering are called suitable duties.

Here are our top three tips for finding suitable duties for a worker recovering from a mental injury.

Tip 1.

Focus on what your worker can do, not what they can't do.

By focusing on your worker and their strengths and abilities, you'll help everyone stay positive.

Tip 2 is to be flexible.

Being flexible with your worker as they recover helps them to build up their confidence.

This might look like offering reduced hours, modifying tasks or providing a different workplace setting like remote work.

Tip 3 Prioritise open communication.

Talk with your worker regularly and listen to their needs and concerns.

This shows you care and helps with making any adjustments needed along the way.

Next up, how do you find duties that are the right fit for your worker and their injury?

You can start by asking your worker what work they think they could safely do as they recover in line with their doctor's advice.

This is a good way to collaborate and build trust.

You can also look at any restrictions on their work capacity.

Certificate together to help you decide.

Speak to Work Cover if you're unsure.

We can share guidance from a worker's doctor or psychologist if it directly relates to helping a worker get back to work.

The next step is to identify duties for your worker based on medical advice and what they can do.

Here are some ideas to start.

Talk to other business areas or look at different job descriptions in your workplace to find tasks outside of your worker's usual role.

Can you reduce the complexity or pace of work?

What technology or tools might help them with their work?

The next step is to have a clear return to work plan in place that outlines what work they'll be doing, timelines and any support measures.

It's important everyone agrees on the plan before starting.

This helps your worker know what to expect and shows them their mental health is taken seriously.

You'll also know when things aren't going as planned so you can make adjustments.

One of the biggest barriers workers face when going back to work after a mental injury is stigma.

You can help create a workplace culture where people know they're valued and supported and they feel comfortable to talk about their mental health.

This might include mental health awareness training.

For more guidance, see our website and subscribe to our YouTube channel.

If you need help in your language, call 1800 512 451 and ask for an interpreter.

In this video, we'll explain what reasonable management action is in mental injury claims to help you confidently manage your workers.

When a work cover claim is lodged, we check it to make sure it meets the criteria for acceptance.

In Queensland, mental injury claims caused by reasonable management action, when it's taken in a reasonable way are excluded from workers compensation.

Management action means steps your workplace takes to manage your workers employment, like giving feedback on or managing a worker's performance, investigating complaints and misconduct, changing a worker's role, taking disciplinary action such as dismissing a worker.

As an employer, you'll decide who to promote or transfer, how to approve leave, and who is eligible for promotion.

It's reasonable for managers and supervisors to allocate work or give feedback on a worker's performance in a fair and constructive way.

Sometimes difficult management decisions at work can lead to a worker feeling uncomfortable and even developing a mental injury.

But if that injury is caused by reasonable management action taken in a reasonable way, then they can't receive workers compensation.

Also, actions can't be considered bullying if they're done in a lawful and reasonable way, taking the unique circumstances into account.

For more guidance on bullying versus reasonable management action, see our website.

It's important to remember that even if a worker's claim is denied due to reasonable management action, they may still have a genuine mental health concern.

Always show empathy and support.

One way you can help is to connect your worker to support services listed on our mental injuries web page.

When we consider whether management action is reasonable or not, we'll look at the actual management action taken rather than the workers perception of it, whether the decision was in line with the workplace's established policies or procedures, and if not, whether it was reasonable in the circumstances.

Management action must be taken in a reasonable way, so it should always be done fairly and it should make sense to an observer.

It's not about being perfect, just fair, objective and sensible.

Here are some practical tips.

One, inform workers about the purpose of any meeting.

Two, Follow established policies and consult where necessary.

Three, Keep records of discussions and decisions.

Four, Offer workers the chance to bring a support person to important or difficult meetings.

Five, Make sure you don't unreasonably delay taking management action.

Subscribe to our YouTube channel for more updates.

If you need help in your language, call 1800 512 451 and ask for an interpreter.