Under the Workers’ Compensation and Rehabilitation Act 2003, WorkCover Queensland is required to provide provisional support for mental injuries. This allows you to access funded psychiatric treatment and psychological counselling before your claim is officially accepted, which can take 20 business days or more.
How to Access Early Support
To qualify for this support, you must have:
- Lodged a claim with WorkCover Queensland; and
- Obtained a Work Capacity Certificate from your GP that confirms a mental injury diagnosis.
What is Covered?
While your application is pending, WorkCover should pay for “reasonable” medical and rehabilitation services, including:
- GP appointments related to your mental health.
- Counselling or psychology sessions.
- Psychiatry appointments and assessments.
- Medication, such as antidepressants, if prescribed for the injury.
- Travel expenses incurred to attend these appointments.
Critical Rules
- No Payback Required: If your claim is ultimately rejected, you do not have to pay back the costs of the treatment you received during the provisional period. Funding simply stops from the date of the decision.
- Exclusions: Provisional support generally does not cover in-patient hospital stays or private hospital costs.
- External Support: You can also access the Workers’ Psychological Support Service (WPSS), which is a free, independent service that helps workers navigate the system and connects them with community support.
Provisional payments are a critical safety net that allow you to receive help while your claim is under investigation. Here is the breakdown of how long they last and what occurs if your claim is not accepted.
Timeframes for Provisional Support
- Duration: In Queensland, provisional payments for psychiatric injuries typically last until a decision is made on your claim or for a maximum of 13 weeks.
- Standard Assessment Window: WorkCover aims to decide on psychological claims within 20 business days. However, complex cases—especially those involving consideration of “reasonable management action” issues—often take longer.
- No Repayment: If your claim is eventually rejected, you are not required to pay back any of the medical or pharmaceutical costs covered during the provisional period.
What Happens if Your Claim is Rejected?
If WorkCover rejects your claim, you will receive a “Reasons for Decision” letter. At this point:
- Treatment Funding Stops: The provisional payments for your doctor, psychologist, or medication will cease immediately.
- Right to Review: You have three months from the date you receive the rejection letter to lodge a formal Application for Review with the Workers’ Compensation Regulator.
- Independent Review Process: The Regulator is independent of WorkCover. They typically make a decision within 25 business days.
- Further Appeal: If the Regulator also rejects your claim, you have 20 business days to appeal that decision to the Queensland Industrial Relations Commission (QIRC).
It is recommended that you seek legal advice first before lodging a claim. Your expert personal injury lawyer will provide you with some guidance and assistance with respect to the lodgement of your claim. Should your claim be rejected, it is critical that you seek legal advice, as trying to manage the appeal process yourself is fraught with danger.
