Complete guide to QLD workers' compensation insurance
All employers in Queensland are required to hold workers compensation insurance for all workers. In QLD, this type of “normal” workers compensation policy is often known as accident insurance. A worker can be defined as anyone doing a job under a contract of service, and most employees will naturally fall into this category.
Contractors are not workers, and you are not required to purchase accident insurance workers compensation cover for them. Other individuals in certain situations and occupations are also exempt. These exemptions, and how to differentiate workers and contractors, are explained further below.
Workers compensation in Queensland is managed by the state government. Although you cannot shop around for different insurers, you are able to choose from several different policy types.
|QLD||What is it?|
|Accident insurance||Standard, mandatory workers compensation. Covers you against employee claims for workplace injuries and death, including psychological, gradual and latent injuries, and aggravation of pre-existing conditions|
|Household worker insurance||You must take out this policy for any household workers you employ. These are workers you employ solely to work on or around your home, including contractors. This includes cleaners, nannies, gardeners, in-home carers and similar.|
|Workplace personal injury insurance||Optional workplace insurance for individuals who, other than as a worker, receive remuneration or benefit from the policyholder. You are able to take this policy out on yourself.|
|Self Insurance||Eligible large companies with 2,000+ employees may register as self-insurers|
There are no remuneration thresholds to meet. If someone qualifies as a worker you must cover them, regardless of how much they are paid.
- Workers will always be individual people. You are not required to cover organisations or groups you have hired, except as individuals who individually qualify as your workers.
- Company directors, trustees working on behalf of a trust, and partners in a partnership do not count as workers and cannot get covered with accident insurance.
- Contractors do not count as workers, and do not require cover. You can tell the difference between workers and contractors by using the table and tools below.
|Cannot subcontract the tasks they perform||Contractors are free to pay someone else (subcontractors) to do the job at hand|
|The worker is paid hourly for the time worked, piece work or earns a commission||Contractors are paid for results achieved based on a quote they have provided|
|The worker is not legally liable for the cost of rectifying defects. Their employer is.||Contractors are personally liable for their work and the cost of rectifying defects|
|Workers can be directed how to carry out tasks by their employers||Contractors have freedom in how work is done, subject to the terms of a given contract, and typically provide their required tools and equipment without being paid an allowance for them|
|The worker does not operate independently of the employer’s business. They work within and are considered part of the business.||Contractors operate their own business independent to the employer, and are free to accept or refuse additional work|
- If the above table is not enough to clearly distinguish workers from contractors, use the ATO employee/contractor decision tool to get an answer. WorkCover QLD will accept the results of this tool for claims and insurance purposes.
Other people who are specifically excluded from accident cover, even if they meet the other definitions of a worker, are:
- Professional sportspeople
- Members of fishing vessel crews paid wholly or mainly by the gross profits of that vessel
- Driving instructors, or anyone who otherwise earns tuition from a motor vehicle
- People who participate in an approved program or work for unemployment payment
- People with a personal services business determination (PSBD). This is a written notice from the Australian Tax Office confirming that the individual is a personal services business.
All these exempt individuals do not need to be covered by personal accident workers compensation insurance.
Other occupations, including commission-only salespersons, some share farmers and people engaged by labour hire agencies do need workers compensation cover regardless of whether they meet other eligibility criteria.
- All workers need to be covered by accident insurance.
- Is is mandatory to provide household worker insurance cover for certain domestic workers
- Larger businesses with the resources to manage their own workers compensation schemes may be eligible for self insurance.
- Sole traders and other individuals who cannot get accident insurance may want to take out workplace personal injury insurance instead.
Accident insurance workers compensation premiums are calculated based on the size of your business, your industry and your claims history.
For businesses with more than $1.5 million in wages: Accident insurance premiums for these companies are calculated with an experience based rating (EBR). This determines your premiums based on a combination of:
- Any statutory claims made against you in the last three years, when an injured worker claims no-fault benefits after an injury
- Any common law workers compensation claims made against you in the last four years, when an injured worker sues for at-fault benefits, alleging their employer is at least partly liable for the accident
- Your business size relative to the size of your industry, as determined by wages
For businesses with $1.5 million or less in wages: A simplified premium model is used to determine accident insurance premiums for small businesses paying $1.5 million or less in wages per year. Businesses are assigned a rating from 1 to 5 based on their claims experience relative to the industry standard. In other words, a safer than usual workplace will lead to better ratings. These ratings directly affect your premiums, getting you either a discount or a surcharge on the industry standard rates.
|Rating Category||Premium Rate|
- Employers can only move a maximum of one category per year, and will never get a resulting premium change of more than 10% from year to year
- New employers start at rating 3
- Employers who surpass Rating 1 may receive an additional 5% premium rate reduction
- Employers who fall below Rating 5 will be reviewed on a case by case basis
How are personal workplace injury premiums calculated?
Workplace personal injury insurance may be an effective option for sole traders, contractors and others who do not qualify for personal accident insurance.
If an injury or accident leaves you unable to work, this type of insurance can pay weekly benefits, usually of about 85% your usual income, until you are able to work again. It can also pay medical and rehabilitation costs, travelling expenses, death benefits and lump sum payments, much like typical workers compensation cover.
- Minimum annual premiums are currently $1,650 for a full financial year
- Premium rates are based on your industry, day-to-day activities and usual earnings
What are the excess costs?
As with other insurance, employers holding accident cover workers compensation insurance will need to pay an excess in the event of a claim. The excess is the lesser of either $1,456 (in 2016) for workers with above state average income, or that worker’s normal weekly earnings.
Instead of this being paid to the insurers, this excess is paid straight to the worker as their first weekly benefit payment.
om 1 July 2015, the excess amount is calculated as the lesser of:
- 100% of Queensland full-time adult's ordinary time earnings (QOTE) (this amount is declared annually by the Australian Statistician) or
- the worker's weekly compensation (in most cases this is 100% of the award or 85% of normal weekly earnings, whichever is the greater).
QOTE is $1,456.90 (this rate applies to all claims with a date of injury on or after 1 July 2015). The amount payable for the excess is set out in the Act under sections 65 and 66. For claims with an injury date before 1 July 2015 or for more information on excess and how it is calculated, call us on 1300 362 128.
WorkCover QLD insurance can provide:
- Weekly compensation for lost income
- Medical, surgical and hospital expenses
- Rehabilitation treatment, and related equipment or services
- Travel and other expenses
- Death benefits
- Cover of common law damages
It will not cover the cost of:
- Damage to clothing or jewellery
- Vehicle damage for injuries that occurred on the way to or from work
- Unauthorised or unnecessary medical expenses
Weekly compensation payments
If an injury requires a worker to take time off or cut back their hours, they may be entitled to benefits for loss of income. Whether this is necessary will be included on the injured worker’s work capacity doctor’s certificate. Weekly benefits will depend on the length of time someone is certified as being unfit for work, when the injury occurred and other specifics of the situation. Weekly compensation payments will stop when:
- A worker is no longer injured and returns to work
- A lump sum offer has been received or a settlement agreed on
- There have been 5 years of weekly payments
- The total amount paid in weekly compensation reaches the maximum applicable limit
Medical and rehabilitation costs
Once a claim has been accepted, WorkCover QLD may pay reasonable medical and rehabilitation expenses relating to a claim. There are set fee lists for medical services, much like with Medicare. You can find the set fees for essential medical treatments here, and the set fees for allied healthcare services, such as physiotherapy, here. If you use a provider who charges more than the fees listed on those pages, you will be responsible for paying the difference. Treatments are only covered when:
- They are clear medical treatments provided by a registered professional, such as a doctor, dentist or physiotherapist.
- Surgical and hospital expenses, such as bandages and prescription drugs, must be essential to a worker’s recovery
- Rehabilitation treatments, services and equipment such as rehabilitation therapies, wheelchairs and prosthetics must be a required part of the worker’s recovery.
In most cases the medical practitioner will send the bill directly to WorkCover, but sometimes an injured worker may need to pay for the treatment at a the time. In this case they should clearly mark the receipts with their name and claim number and send them in to WorkCover QLD. They can be uploaded online here, can be faxed to 1300 651 387, or mailed to GPO Box 2459, Brisbane, QLD 4001.
Travel and other expenses
Necessary and reasonable travel costs, including for medical treatments and medical assessments are covered by QLD workers compensation. Travel for one-way trips less than 20km away or where there is a closer option available is not covered. Other reimbursements include:
- Parking costs for medical treatment or rehabilitation, medical assessment tribunal visits, or independent medical assessments
- Meals when whole-day or overnight travel is required
- Reasonable itemised chemist expenses directly related to the work injury
- Equipment provided by a treating provider which can improve function or assist the employee in returning to work
Lump sum permanent impairment payments
If an injured worker has permanent impairment as a result of a workplace injury they may be entitled to lump sum compensation. Impairment can generally be distinguished by the permanent loss of efficient use of a specific body part, or of a general part of the body.
- The size of the lump sum payment depends on the worker’s degree of impairment
- To claim lump sum benefits, an injured worker must first be assessed for permanent impairment. They may request this themselves, or WorkCover QLD might decide to have them assessed.
- Injured workers are not required to retain a lawyer for lump sum assessments. These benefits are a purely medical decision.
Dependents of a deceased worker may claim lump sum or quarterly benefit payments, as well as reasonable funeral expenses. The requirements can be complex and WorkCover QLD encourages claiming dependents to call 1300 362 128 for a clear idea of what is required. Claiming family members may need to show:
- Proof of financial dependence on the deceased
- That they are a partner or child of the worker
- Medical evidence to support the claim
Common law damages
When an injured worker sues their employer for damages, WorkCover QLD represents the employer and can pay the damages, including:
- Past and future loss of income
- Medical treatments
- Pain and suffering
- Legal costs
- You must take out an accident insurance (standard workers compensation) policy for all workers
- You must take out household workers insurance when employing domestic workers around the house
- You may take out workplace personal injury insurance to get personal workers compensation type cover even if you’re not eligible for accident insurance.
- You may opt for self insurance instead as a large and profitable company with 2,000+ workers