How does WorkCover investigate my claim? < Back

Will I have to attend medical examinations?
Attending medical examinations is a necessary part of a WorkCover claim. Failure to attend examinations at reasonable intervals may result in the suspension of a claim.

Most medical examiners attempt to determine exactly what your injury is on the basis of clinical signs of injury. A minority of medical examiners retained by WorkCover conduct brief and superficial examinations and provide reports that routinely assert that a claimant does not have an injury or is able to work. These examiners are well-known to the courts and lawyers practising in the WorkCover jurisdiction. Little weight is placed on the results of these examinations by courts. Attending medical examinations can be stressful, but some simple steps will make an examination less stressful. (Click here for more information)

Will WorkCover ask me to make a statement about my injury?
A claimant may be asked to provide a statement to WorkSafe about the circumstances of their injury. A request for a statement can come from two different sections of WorkCover;
  • Where a significant injury is involved, a request will often be made by WorkSafe investigators who are trying to determine the precise cause of injury and will be considering prosecuting an employer or other party for a breach of an Occupational Health and Safety regulation.

  • A request may also be made by an investigator who has been retained by the claims management section of WorkCover, through a claims agent. The purpose of this investigation would be to determine whether liability should be accepted for a claim and/ or whether any other person might have caused the injury. If an injury was negligently caused by a third-party, WorkCover is entitled to sue that third-party to recover any amount paid out on the claim.
 Should I make/give a statement to WorkCover about my injury?
Deciding whether or not to give a statement is a very complex issue. There is no obligation on you to provide a statement. If you have been involved in a major incident, and there is any prospect of your own conduct being called into question it can be very important not to provide a statement without legal advice. An investigator who has requested you provide a statement will always respect a request for you to consult a legal advisor before making a statement.

If you have suffered a significant injury that is likely to have long-term effects, it can be particularly important to provide a statement to WorkCover, but only in the presence of a legal adviser. A legal advisor can ensure that the statement is completely accurate. Some words which can be included in a statement, may appear to be harmless, but may cause complications further on in a case. For example, if a claimant suffered a major injury, and in describing their injury they stated "that it is possible they may have been distracted", this might be used later on by WorkCover as the basis of an allegation of contributory negligence.

Many claimants wish to make a statement on the basis that they have nothing to hide and that they are keen to tell WorkCover about how their injury occurred. This position is understandable. Refusing outright to give a statement, may result in a claim being rejected. Some investigators may imply that the claim is very straightforward and that all that is finally needed is a statement to make sure that it goes through. This is rarely the case. Remember, no matter how supportive and compassionate an investigator may seem, their job is to determine whether there are any grounds for a claim to be rejected. (Click here for tips on how to give a statement)
Will WorkCover try to film me?
Surveillance of claimants under WorkCover does occur from time to time. The incidence of surveillance is much less than the public perception of its frequency. Nonetheless it is not uncommon for it to occur.

The cases where it is most likely to occur are the following types of claims where:
  • The injury is not readily demonstrable,

  • Employers are strongly resistant or hostile to a claim,

  • A claimant has been in receipt of weekly payments for an extended period

  • Disaffected persons, e.g. former partners, neighbours or relatives etc have made a report to WorkCover about activity.
The WorkCover Authority considers that surveillance of a claimant is a legitimate tool for management of a claim. The WorkCover Authority does however issue of code of conduct to its investigators under which they are expected to operate. Click here for PDF document Code of Practice for Private Investigators and link to WorkSafe website www.worksafe.vic.gov.au. The use of surveillance can occur at any time during a claim and is not limited just to long term claims or court cases.

Occasionally, information from surveillance can cause considerable damage to a WorkCover claim but this is most commonly limited to those cases where there is clear dishonesty. For example, film of a claimant working smashing a concrete block with a sledgehammer, could destroy the claim for compensation for a back injury. These cases of dishonesty are rare. Most of the difficulties that result from surveillance do not come from the film or information itself but from its effect on a claimant's general credibility. It is common, in the course of the case, for a WorkCover medical examiner to ask a claimant about whether they can undertake various activities. Similarly in some court cases a claimant can be asked whether they are able to undertake activity such as washing the car. If a claimant denies an ability to undertake this activity, but is subsequently shown on film or other evidence, to be doing this activity then this will affect the claimant's credibility generally.

Using our example above, if a claimant was asked whether or not they wash their car, or mow their lawn etc and answer that they do so but have some increased pain afterwards, it will usually not negatively affect the case in any way. In this circumstance, the film of the particular activity will not cause any difficulty. Where there is a clear denial of undertaking that activity, a film will have an effect, not because of the activities shown but rather because of the claimant's denial of undertaking the activity. The claimant's credibility will be negatively affected.

What should I do if I think I am being filmed?
  • Live your life within the terms of your disability and undertake whatever activities you think appropriate to your disability. If you are thinking about undertaking a major activity in the future, tell your doctor about it and ask their advice about its suitability. Your enquiry will be recorded in the doctor's notes and can be relied upon by you if necessary.

  • Do not overreact to the prospect of surveillance. It is sometimes possible to misinterpret innocent or normal activities as surveillance. In rare circumstances someone watching your movements may be unconnected with your WorkCover claim and maybe linked to some worrying activity, for example planning a break-in to steal from your home. If you are concerned about this prospect you should ring the police and notify them of your concerns. Taking a record of vehicle numbers will be of some help. If the activity is in fact related to your claim the police will not advise you of this specifically, but may indicate that you should not be concerned about some possible criminal activity.

  • If you commence any paid employment make sure you notify the relevant WorkCover Authority or your lawyer.

  • When asked about what activities you can and cannot undertake, be particularly careful to specify the activities that you can do. You can go on to explain how each activity affects your level of pain etc.

  • If you have information that your surveillance has breached a law such as trespass, photographing children without permission etc then you can report that conduct to direct to The Assessment Centre on 03 9641 1051 or contact the WorkCover Authority on 1800 136 089.

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