This section includes forms required for claims, disputes and general administrative processes within the scheme.
If you require help when filling out any forms, please contact our Advice and Assistance Service on 1300 794 744.
A selection of our printed publications are available to stakeholders free of charge. To order publications, complete the Publication Order Form and email to communications@workcover.wa.gov.au
Worker resourcesWorkers Compensation Claim Form
The claim form includes information on the claims process and your rights, responsibilities and entitlements when making a claim for workers compensation.
Workplace Fatality Compensation Claim Form
Dependants of deceased workers should refer to Workplace fatality claims for further information about making a claim.
Common law election form
This form is used when you are pursuing a common law claim against your employer.
Non-resident worker – incapacity declaration
This form is used to declare an injured workers’ incapacity when the injured worker does not reside in Western Australia.
Noise Induced Hearing Loss Claim Form
This form is to be used by workers to make a claim for noise induced hearing loss.
Learn more about making a claim for noise induced hearing loss.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronic version of the Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Conciliation
Complete this form to apply to have your dispute dealt with by the Workers Compensation Conciliation Service.
Statement of Social and Financial Circumstances
Complete and lodge this form with the Application for Conciliation when applying for; additional income compensation; or a standard increase in the medical and health expenses general limit amount; or an increase for special expenses in the medical and health expenses general limit amount.
Application for Order for Insurer to Make Payment
Complete this form to apply to the Director for an order for an insurer to make payment where the employer was previously directed to do so by a Conciliator.
Notice of Representation
Complete this form to notify the Director of your appointment or cessation as a representative.
Notice of Multiple Respondents
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Conciliation.
Notice of Discontinuance
Complete this form to notify the Director that you wish to discontinue conciliation of a dispute
Memorandum of Consent to Finalising Order
Complete this form to notify the Conciliation Service of the orders the parties have consented to in order to finalise the dispute.
Application for Order and/or Assessment of Costs
Complete this form if you wish to apply to the Conciliator for an order and/or assessment of costs.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Arbitration
Complete this form to apply to have your dispute dealt with by the Workers’ Compensation Arbitration Service.
Application for Arbitration Workplace Fatality Compensation
Complete this application for a workplace fatality claim to be determined by the Workers Compensation Arbitration Service.
Application to Extend Time to Lodge an Application for Arbitration
Complete this form to apply for an extension of time to lodge an Application for Arbitration.
Statement of Social and Financial Circumstances
Complete this form and lodge with the Application for Arbitration when applying for additional income compensation or a standard increase in the medical and health expenses general limit amount and/or an increase for special expenses in the medical and health expenses general limit amount.
Reply to an Application for Arbitration
Complete this form to reply to an application for arbitration.
Certificate that Document was Given
Complete this form to certify you have given documents pursuant to the Arbitration Rules
Interlocutory Application
Complete this form to lodge an Interlocutory Application.
Notice Consenting or Opposing Interlocutory Application
Complete this notice to reply to an Interlocutory Application
Memorandum of Consent Order
Complete this form to seek consent orders from an arbitrator
Order for Production of Documents or Material
Complete this form and lodge it with an Interlocutory Application when requesting an order to produce documents.
Summons to Witness
Complete this form if you are seeking a summons to be issued by the Registrar or an arbitrator requiring the attendance of a person before an arbitrator.
Multiple Respondent Form
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Arbitration.
Notice of Representation
Complete this form to notify the Workers Compensation Arbitration Service of an appointment or cessation of representation.
Notice of Discontinuance
Complete this form if you wish to discontinue arbitration of the dispute.
Application for Order and/or Assessment of Costs
Complete this application if you wish to apply to the arbitrator or the Registrar for an order and/or assessment of costs.
Notice Consenting or Opposing Application for Order and/or Assessment of Costs
Complete this form in response to an Application for Order and/or Assessment of Costs.
Arbitration Order for Joinder of Party
Complete this form to give notice of an arbitrator’s order that another person be joined as a party to the proceedings.
Workers Compensation and Injury Management: A Guide for Workers
A comprehensive guide to assist you through the workers compensation process, injury management and return to work.
Fact Sheet – Return to Work Worker Obligations
This fact sheet outlines the obligations of the worker throughout the return to work process.
A Guide to Noise Induced Hearing Loss
A comprehensive guide on your obligations regarding noise induced hearing loss.
Work related hearing loss claims – Employer and worker fact sheet
A fact sheet that outlines the process of claims for noise induced hearing loss for workers and employers.
NIHL Directory of Service Providers
A directory of approved hearing testers in Western Australia.
Dust Disease Claims Fact Sheet
Silicosis Claims in the Engineered Stone Benchtop Industry
This fact sheet provides information on setting out the process for making a compensation claim for workers with a provisional or confirmed diagnosis of silicosis, and the responsibility of insurers where a claim has been made.
Template Injury Management System
This template will assist employers to devise an appropriate injury management system for their workplace.
Return to Work Program
This template will assist employers to devise an appropriate Return to Work Program collaboratively with the injured worker.
Workplace Rehabilitation Referral Form
This form can be used by workers, employers or treating medical practitioners to request a referral to a workplace rehabilitation provider.
Non-resident worker – incapacity declaration
This form is used to declare an injured worker’s incapacity when the injured worker does not reside in Western Australia.
Intention to reduce or discontinue income compensation – consent
This form is required if you and the worker consent to reduce or discontinue income compensation.
Intention to reduce or discontinue income compensation – return to work
This form is required if you intend to reduce or discontinue income compensation as a result of worker returning to work.
Intention to reduce or discontinue income compensation – medical evidence
This form is required if you intend to reduce or discontinue income compensation as a result of medical evidence.
Custody or imprisonment notice
This form is required if you intend to discontinue income compensation as a result of worker in custody or imprisonment.
Intention to dismiss worker notice
This form is required if you intend to dismiss a worker during the employment obligation period.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronic version of the Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Conciliation
Complete this form to apply to have your dispute dealt with by the Workers Compensation Conciliation Service.
Statement of Social and Financial Circumstances
Complete and lodge this form with the Application for Conciliation when applying for; additional income compensation; or a standard increase in the medical and health expenses general limit amount; or an increase for special expenses in the medical and health expenses general limit amount.
Application for Order for Insurer to Make Payment
Complete this form to apply to the Director for an order for an insurer to make payment where the employer was previously directed to do so by a Conciliator.
Notice of Representation
Complete this form to notify the Director of your appointment or cessation as a representative.
Notice of Multiple Respondents
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Conciliation.
Notice of Discontinuance
Complete this form to notify the Director that you wish to discontinue conciliation of a dispute
Memorandum of Consent to Finalising Order
Complete this form to notify the Conciliation Service of the orders the parties have consented to in order to finalise the dispute.
Application for Order and/or Assessment of Costs
Complete this form if you wish to apply to the Conciliator for an order and/or assessment of costs.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Arbitration
Complete this form to apply to have your dispute dealt with by the Workers’ Compensation Arbitration Service.
Application for Arbitration Workplace Fatality Compensation
Complete this application for a workplace fatality claim to be determined by the Workers Compensation Arbitration Service.
Application to Extend Time to Lodge an Application for Arbitration
Complete this form to apply for an extension of time to lodge an Application for Arbitration.
Statement of Social and Financial Circumstances
Complete this form and lodge with the Application for Arbitration when applying for additional income compensation or a standard increase in the medical and health expenses general limit amount and/or an increase for special expenses in the medical and health expenses general limit amount.
Reply to an Application for Arbitration
Complete this form to reply to an application for arbitration.
Certificate that Document was Given
Complete this form to certify you have given documents pursuant to the Arbitration Rules
Interlocutory Application
Complete this form to lodge an Interlocutory Application.
Notice Consenting or Opposing Interlocutory Application
Complete this notice to reply to an Interlocutory Application
Memorandum of Consent Order
Complete this form to seek consent orders from an arbitrator
Order for Production of Documents or Material
Complete this form and lodge it with an Interlocutory Application when requesting an order to produce documents.
Summons to Witness
Complete this form if you are seeking a summons to be issued by the Registrar or an arbitrator requiring the attendance of a person before an arbitrator.
Multiple Respondent Form
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Arbitration.
Notice of Representation
Complete this form to notify the Workers Compensation Arbitration Service of an appointment or cessation of representation.
Notice of Discontinuance
Complete this form if you wish to discontinue arbitration of the dispute.
Application for Order and/or Assessment of Costs
Complete this application if you wish to apply to the arbitrator or the Registrar for an order and/or assessment of costs.
Notice Consenting or Opposing Application for Order and/or Assessment of Costs
Complete this form in response to an Application for Order and/or Assessment of Costs.
Arbitration Order for Joinder of Party
Complete this form to give notice of an arbitrator’s order that another person be joined as a party to the proceedings.
Workers Compensation and Injury Management: A Guide for Employers
A comprehensive guide to assist you with your workers compensation and injury management obligations in accordance with the Workers Compensation and Injury Management Act 2023.
Workers Compensation Insurance – Employer Essentials Fact Sheet
This fact sheet offers essential information to assist employers in meeting their obligations under the Workers Compensation and Injury Management Act 2023.
Uninsured Workers Compensation Claims Fact Sheet
This fact sheet outlines why having it is an obligation to have workers compensation insurance, and what happens when a worker is not covered following an injury at work.
Return to Work Employer Obligations Fact Sheet
This fact sheet outlines the obligations of the employer to assist an injured worker’s safe and sustainable return to work.
A Guide to Noise Induced Hearing Loss
A comprehensive guide on your obligations regarding noise induced hearing loss.
Work related hearing loss claims – Employer and worker fact sheet
A fact sheet that outlines the process of claims for noise induced hearing loss for workers and employers.
NIHL Directory of Service Providers
A directory of approved hearing testers in Western Australia.
Premium and Industry Classification Review Guidelines
The Guidelines inform and guide employers, insurance brokers (and employer authorised representatives) of WorkCover WA’s processes and steps applicable to premium and industry classification reviews.
Workers Compensation and Injury Management Conciliation Rules 2024
The Conciliation Rules support the arrangements for resolving workers compensation disputes in Western Australia. All parties to a dispute need to comply with the Conciliation Rules.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronic version of the Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Conciliation
Complete this form to apply to have your dispute dealt with by the Workers Compensation Conciliation Service.
Statement of Social and Financial Circumstances
Complete and lodge this form with the Application for Conciliation when applying for; additional income compensation; or a standard increase in the medical and health expenses general limit amount; or an increase for special expenses in the medical and health expenses general limit amount.
Application for Order for Insurer to Make Payment
Complete this form to apply to the Director for an order for an insurer to make payment where the employer was previously directed to do so by a Conciliator.
Notice of Representation
Complete this form to notify the Director of your appointment or cessation as a representative.
Notice of Multiple Respondents
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Conciliation.
Notice of Discontinuance
Complete this form to notify the Director that you wish to discontinue conciliation of a dispute
Memorandum of Consent to Finalising Order
Complete this form to notify the Conciliation Service of the orders the parties have consented to in order to finalise the dispute.
Application for Order and/or Assessment of Costs
Complete this form if you wish to apply to the Conciliator for an order and/or assessment of costs.
Workers Compensation and Injury Management Arbitration Rules 2024
The Arbitration Rules support the arrangements for resolving workers compensation disputes in Western Australia. All parties to a dispute need to comply with the Arbitration Rules.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Arbitration
Complete this form to apply to have your dispute dealt with by the Workers’ Compensation Arbitration Service.
Application for Arbitration Workplace Fatality Compensation
Complete this application for a workplace fatality claim to be determined by the Workers Compensation Arbitration Service.
Application to Extend Time to Lodge an Application for Arbitration
Complete this form to apply for an extension of time to lodge an Application for Arbitration.
Statement of Social and Financial Circumstances
Complete this form and lodge with the Application for Arbitration when applying for additional income compensation or a standard increase in the medical and health expenses general limit amount and/or an increase for special expenses in the medical and health expenses general limit amount.
Reply to an Application for Arbitration
Complete this form to reply to an application for arbitration.
Certificate that Document was Given
Complete this form to certify you have given documents pursuant to the Arbitration Rules
Interlocutory Application
Complete this form to lodge an Interlocutory Application.
Notice Consenting or Opposing Interlocutory Application
Complete this notice to reply to an Interlocutory Application
Memorandum of Consent Order
Complete this form to seek consent orders from an arbitrator
Order for Production of Documents or Material
Complete this form and lodge it with an Interlocutory Application when requesting an order to produce documents.
Summons to Witness
Complete this form if you are seeking a summons to be issued by the Registrar or an arbitrator requiring the attendance of a person before an arbitrator.
Multiple Respondent Form
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Arbitration.
Notice of Representation
Complete this form to notify the Workers Compensation Arbitration Service of an appointment or cessation of representation.
Notice of Discontinuance
Complete this form if you wish to discontinue arbitration of the dispute.
Application for Order and/or Assessment of Costs
Complete this application if you wish to apply to the arbitrator or the Registrar for an order and/or assessment of costs.
Notice Consenting or Opposing Application for Order and/or Assessment of Costs
Complete this form in response to an Application for Order and/or Assessment of Costs.
Arbitration Order for Joinder of Party
Complete this form to give notice of an arbitrator’s order that another person be joined as a party to the proceedings.
Guide to the Workers Compensation Conciliation Service
This guide outlines how to commence conciliation and what to expect during the process.
What happens if there is a dispute?
This fact sheet provides an overview of the dispute resolution processes provided by WorkCover WA.
Guide to the Workers Compensation Arbitration Service
This guide outlines how to commence arbitration and what to expect during the process.
What happens if there is a dispute?
This fact sheet provides an overview of the dispute resolution processes provided by WorkCover WA.
General practitioners perform an integral function in progressing the medical forms for workers compensation claims.
First Certificate of Capacity
Progress Certificate of Capacity
Final Certificate of Capacity
Form APIA1: Permanent Impairment Assessment – report and certificate
This form is used by the APIA to produce a report certifying a worker’s degree of permanent impairment. The approved permanent impairment assessor is to forward this report to the worker, the employer and the employers insurer.
Form APIA2: Permanent Impairment Assessment – request
This form is used by worker, insurer, or self-insurer to request assessment of workers degree of permanent impairment.
Form APIA3: Permanent Impairment Assessment – requirement to attend
This form indicates a requirement to attend an impairment assessment.
Form APIA4: Permanent Impairment Assessment – provision of information
This form is used when an approved permanent impairment assessor requires a worker, employer or employer’s insurer to produce relevant documents and information to assist in the impairment assessment. The worker, employer or employer’s insurer must provide relevant documents or information to the approved permanent impairment assessor.
Form APIA5: Permanent Impairment Assessment – consent to provision of information
This form is used by an approved permanent impairment assessor when they require consent from the worker, employer or employer’s insurer, for another party to provide relevant documents or information required for the impairment assessment.
Form APIA6: Permanent Impairment Assessment – condition not stabilised notice
The approved permanent impairment assessor uses this form when the worker has been assessed, but their injury has not stabilised to the extent required by the Act and the WorkCover WA Guides for the Evaluation of Permanent Impairment. The approved permanent impairment assessor is to forward this report to the worker, the employer and the employers insurer.
Form APIA7: Permanent Impairment Assessment – Psychiatric impairment rating form
The approved permeant impairment assessor uses this form when the impairment assessment involves a psychiatric injury.
Form Permanent Impairment Notice
This form is used by the worker and employer to indicate whether or not the employer agrees with the assessed degree of permanent impairment.
Form Permanent Impairment – further assessment
This form is used by the employer to request a further assessment if the employer does not agree with the assessed degree of permanent impairment. the cost of further assessment to be paid by the employer.
WorkCover WA Guidelines for the Evaluation of Permanent Impairment – 1 July 2024
This guide is used by Approved Permanent Impairment Assessors when evaluating the degree of an injured worker’s permanent impairment.
WorkCover WA Guidance Notes for Approved Permanent Impairment Assessors – procedures for the permanent impairment assessment process – Coming soon
Outlines the methodology, process and terminology of the impairment assessment process.
APIA Application Pack – SPECIALIST – Medical Practitioners
Information on how to apply to become a specialist APIA medical practitioner.
APIA Application Pack – NON-SPECIALIST – Medical Practitioners
Information on how to apply to become a non-specialist APIA medical practitioner.
Register of approved workplace rehabilitation providers (WorkCover WA Online)
Completed applications should be emailed to records@workcover.wa.gov.au.
Applications to become an approved workplace rehabilitation providerWorkplace Rehabilitation Provider Guidelines
Application for Approval as a Workplace Rehabilitation Provider Form
Workplace Rehabilitation Providers Principles and Standards of Practice (Principles and Standards)
The Principles and Standards were developed to outline WorkCover WA’s baseline expectations of WRPs operating in the scheme.
Principles of Practice for Workplace Rehabilitation Providers (Principles)
WorkCover WA is a signatory to the Principles developed by the Heads of Workers’ Compensation Authorities, and any organisation seeking to become an approved WRP will need to demonstrate that they conform to the Principles.
Workplace Rehabilitation Providers Capability Framework
The Capability Framework sets out the practices, skills, and behaviours expected of workplace rehabilitation providers in the Western Australia workers compensation scheme, on entry to the industry and throughout their career.
Foundations of Workers Compensation: Workplace Rehabilitation Providers
This easy to navigate online course is designed to assist WRPs to improve their knowledge of the workers compensation scheme, and develop the skills required to optimise their performance and client service delivery.
WorkCover WA Online User Guide – Workplace Rehabilitation Providers
A user guide for WRPs learning to use WorkCover WA Online.
Information Sheet – Workplace Rehabilitation – Worker’s Status at Referral and Closure
Information on declaring a worker’s status at referral and closure of their workplace rehabilitation.
Information Sheet – Workplace Rehabilitation – Closure Reasons
Information on valid reasons for closing a workers workplace rehabilitation program.
Return to work program
Form used when developing a return-to-work program.
Workplace Rehabilitation Referral
Form used when referring an injured worker to a WRP.
Service Delivery Plan
Form used when developing a service delivery plan.
Workplace Rehabilitation Referral Closure
Form used when closing a worker’s workplace rehabilitation program.
Consent Form
A form that assists WRPs in advising workers of their rights, responsibilities and conflicts of interest.
Referral Checklist
A checklist of items that need to be completed upon a worker’s referral to your organisation.
Initial Assessment Report
The report completed at commencement of a worker’s rehabilitation to assess their current health.
Progress Report
The report that’s completed throughout a worker’s rehabilitation to track their progress.
Closure Report
The report that’s completed upon closure of a worker’s workplace rehabilitation.
NIHL Directory of Service Providers
A directory of approved hearing testers in Western Australia.
For forms and fact sheets, visit the Noise induced hearing loss section on the Resources page.
The Insurer and Self-insurer Principles and Standards of Practice outline WorkCover WA’s baseline expectations of insurers and self-insurers operating in the scheme.
The Claims Managers Capability Framework sets out the practices, skills and behaviours expected of claims managers in the Western Australia workers compensation scheme.
The Capability Framework translates the Insurer and Self-insurer Principles and Standards of Practice into observable practices and behaviours which claims managers should demonstrate when delivering scheme services.
Foundations of Workers Compensation: Claims Managers
This easy to navigate online course is designed to assist Claims Managers to improve their knowledge of the workers compensation scheme, and develop the skills required to optimise their performance and client service delivery.
The Clinical Framework for the Delivery of Health Services (Clinical Framework) is an evidence-based guide designed to support healthcare practitioners delivering services to people with compensable injuries. Developed by the Transport Accident Commission (TAC) and the Victorian WorkCover Authority, this framework reflects contemporary research and has been widely endorsed by Australian workers compensation jurisdictions, as well as peak health associations.
WorkCover WA endorses the use of the Clinical Framework by medical and allied health practitioners delivering services to injured workers in Western Australia.
The Clinical Framework outlines five principles shown to deliver optimal recovery and return to work outcomes for injured workers.
- Measure and demonstrate the effectiveness of treatment.
- Adopt a biopsychosocial approach.
- Empower the injured person to manage their injury.
- Implement goals focused on optimising function, participation and return to work.
- Base treatment on best available research evidence.
We encourage you to use and share the framework with your colleagues, patients (injured workers), employers and workplace rehabilitation providers in working towards optimal outcomes in recovery and return to work.
Data directions under section 500 of the Workers Compensation and Injury Management Act 2023 requires data and information relating to workers compensation policies and claims to be provided to WorkCover WA in the form, manner, and by any timeframes specified in WorkCover WA’s National Insurer Data Specification Guidelines.
WorkCover WA collects data periodically to monitor scheme performance and to set recommended premium rates. Premium rates data is collected through:
- Form WC12 – Statement of policies, premium, wages and claims
- Form WC20 Mid Financial Year – Summary of cost of claims from July to December
- Form WC20 Full Financial Year – Summary of cost of claims from July to June
- Form WC30 – Statement of premiums and expenses associated with the writing of workers compensation business
All Forms are to be submitted via WorkCover WA Online.
Guidelines
The Premium rates data – Guidelines describes data required by WorkCover WA of insurers and self-insurers to set recommended premium rates and monitor scheme performance. Licensed insurers and self-insurers are required to provide data as specified in this document.
Templates
Templates for reporting premium rates data are as follows:
- Form WC12 TEMPLATE
Template for reporting Form WC12 – Statement of policies, premium, wages and claims. - Form WC20 Mid Financial Year TEMPLATE
Template for reporting Form WC20 Mid Financial Year – Summary of cost of claims from July to December. - Form WC20 Full Financial Year TEMPLATE
Template for reporting form WC20 Full Financial Year – Summary of cost of claims from July to June. - Form WC30 TEMPLATE
Template for reporting Form WC30 – Statement of premiums and expenses associated with the writing of workers compensation business.
Sample data
Sample data to show how to complete the templates are as follows:
- Form WC12 SAMPLE
Sample data to show how to complete Form WC12 – Statement of policies, premium, wages and claims. - Form WC20 Mid Financial Year SAMPLE
Sample data to show how to complete Form WC20 Mid Financial Year – Summary of cost of claims from July to December. - Form WC20 Full Financial Year SAMPLE
Sample data to show how to complete Form WC20 Full Financial Year – Summary of cost of claims from July to June. - Form WC30 SAMPLE
Sample data to show how to complete Form WC30 – Statement of premiums and expenses associated with the writing of workers compensation business.
WorkCover WA collects data periodically to monitor scheme performance and to set recommended premium rates. Premium rates data is collected through:
- Form WC20 Mid Financial Year – Summary of cost of claims from July to December
- Form WC20 Full Financial Year – Summary of cost of claims from July to June
- Form WC31 – Statement of expenses associated with the writing of workers compensation claims.
All Forms are to be submitted via WorkCover WA Online.
Guidelines
The Premium rates data – Guidelines describes data required by WorkCover WA of insurers and self-insurers to set recommended premium rates and monitor scheme performance. Licensed insurers and self-insurers are required to provide data as specified in this document.
Templates
Templates for reporting premium rates data are as follows:
- Form WC20 Mid Financial Year TEMPLATE
Template for reporting Form WC20 Mid Financial Year – Summary of cost of claims from July to December. - Form WC20 Full Financial Year TEMPLATE
Template for reporting Form WC20 Full Financial Year – Summary of cost of claims from July to June. - Form WC31 TEMPLATE
Template for reporting Form WC31 – Statement of expenses associated with the writing of workers compensation claims.
Sample data
Sample data for reporting premium rates data are as follows:
- Form WC20 Mid Financial Year SAMPLE
Sample data to show how to complete Form WC20 Mid Financial Year – Summary of cost of claims from July to December. - Form WC20 Full Financial Year SAMPLE
Sample data to show how to complete Form WC20 Full Financial Year – Summary of cost of claims from July to June. - Form WC31 SAMPLE
Sample data to show how to complete Form WC31 – Statement of expenses associated with the writing of workers compensation claims.
Standard Employer Indemnity Policy – Coming soon
The basis of all workers compensation policies.
Premium and Industry Classification Review Guidelines
The Premium and Industry Classification Review Guidelines inform and guide employers, insurance brokers (and employer authorised representatives) of WorkCover WA’s processes and steps applicable to premium and industry classification reviews.
Insurance Brokers Principles and Standards of Practice
The Insurance Brokers Principles and Standards of Practice outline WorkCover WA’s baseline expectations for insurance brokers operating in the Western Australian workers compensation scheme.
Template Injury Management System
This template will assist employers to devise an appropriate injury management system for their workplace.
Return to Work Program
This template will assist employers to devise an appropriate Return to Work Program collaboratively with the injured worker.
Workplace Rehabilitation Referral Form
This form can be used by workers, employers or treating medical practitioners to request a referral to a workplace rehabilitation provider.
Non-resident worker – incapacity declaration
This form is used to declare an injured worker’s incapacity when the injured worker does not reside in Western Australia.
Form 18: Notice of Arrangement of Audiometric Test
This form is used to notify a worker that an audiometric test has been arranged including the appointment details and pre-appointment requirements of the worker.
Form 410: Request for Baseline Full Audiological Assessment
Form used by employers to request a full audiological assessment of a worker.
Noise Induced Hearing Loss Claim Form
This form is to be used by workers to make a claim for noise induced hearing loss.
Learn more about making a claim for noise induced hearing loss.
Workers Compensation and Injury Management: A Guide for Employers
A comprehensive guide to assist you with your workers compensation and injury management obligations in accordance with the Workers Compensation and Injury Management Act 2023.
Workers Compensation Insurance – Employer Essentials Fact Sheet
This fact sheet offers essential information to assist employers in meeting their obligations under the Workers Compensation and Injury Management Act 2023.
Uninsured Workers Compensation Claims Fact Sheet
This fact sheet outlines why having it is an obligation to have workers compensation insurance, and what happens when a worker is not covered following an injury at work.
Return to Work Employer Obligations Fact Sheet
This fact sheet outlines the obligations of the employer to assist an injured worker’s safe and sustainable return to work.
A Guide to Noise Induced Hearing Loss
A comprehensive guide on your obligations regarding noise induced hearing loss.
Work related hearing loss claims – Employer and worker fact sheet
A fact sheet that outlines the process of claims for noise induced hearing loss for workers and employers.
NIHL Directory of Service Providers
A directory of approved hearing testers in Western Australia.
See the current list of registered independent agents.
Workers Compensation and Injury Management Regulations 2024
Link to the Regulations on the Legislation website.
Registered Independent Agent Activity and Costs Record
This template assists Registered Independent Agents to compile ‘Activity and Costs’ records.
Registered Independent Agents: Information for Clients
This fact sheet provides essential information for clients of Registered Independent Agents
Client Acknowledgement of Costs
This template enables clients to confirm their acknowledgement and awareness of costs related to services provided by Registered Independent Agents.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for conciliation. An electronic version of the Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Conciliation
Complete this form to apply to have your dispute dealt with by the Workers Compensation Conciliation Service.
Statement of Social and Financial Circumstances
Complete and lodge this form with the Application for Conciliation when applying for; additional income compensation; or a standard increase in the medical and health expenses general limit amount; or an increase for special expenses in the medical and health expenses general limit amount.
Application for Order for Insurer to Make Payment
Complete this form to apply to the Director for an order for an insurer to make payment where the employer was previously directed to do so by a Conciliator.
Notice of Representation
Complete this form to notify the Director of your appointment or cessation as a representative.
Notice of Multiple Respondents
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Conciliation.
Notice of Discontinuance
Complete this form to notify the Director that you wish to discontinue conciliation of a dispute
Memorandum of Consent to Finalising Order
Complete this form to notify the Conciliation Service of the orders the parties have consented to in order to finalise the dispute.
Application for Order and/or Assessment of Costs
Complete this form if you wish to apply to the Conciliator for an order and/or assessment of costs.
Online lodgement
WorkCover WA provides an online lodgement facility for submitting applications for arbitration. An electronically writeable and printable version of the appropriate application form for use by unrepresented workers, unrepresented dependants or uninsured employers, or when the online system is unavailable, is below.
Forms
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
Application for Arbitration
Complete this form to apply to have your dispute dealt with by the Workers’ Compensation Arbitration Service.
Application for Arbitration Workplace Fatality Compensation
Complete this application for a workplace fatality claim to be determined by the Workers Compensation Arbitration Service.
Application to Extend Time to Lodge an Application for Arbitration
Complete this form to apply for an extension of time to lodge an Application for Arbitration.
Statement of Social and Financial Circumstances
Complete this form and lodge with the Application for Arbitration when applying for additional income compensation or a standard increase in the medical and health expenses general limit amount and/or an increase for special expenses in the medical and health expenses general limit amount.
Reply to an Application for Arbitration
Complete this form to reply to an application for arbitration.
Certificate that Document was Given
Complete this form to certify you have given documents pursuant to the Arbitration Rules
Interlocutory Application
Complete this form to lodge an Interlocutory Application.
Notice Consenting or Opposing Interlocutory Application
Complete this notice to reply to an Interlocutory Application
Memorandum of Consent Order
Complete this form to seek consent orders from an arbitrator
Order for Production of Documents or Material
Complete this form and lodge it with an Interlocutory Application when requesting an order to produce documents.
Summons to Witness
Complete this form if you are seeking a summons to be issued by the Registrar or an arbitrator requiring the attendance of a person before an arbitrator.
Multiple Respondent Form
Complete this form if there is more than one respondent to the dispute and lodge it with the Application for Arbitration.
Notice of Representation
Complete this form to notify the Workers Compensation Arbitration Service of an appointment or cessation of representation.
Notice of Discontinuance
Complete this form if you wish to discontinue arbitration of the dispute.
Application for Order and/or Assessment of Costs
Complete this application if you wish to apply to the arbitrator or the Registrar for an order and/or assessment of costs.
Notice Consenting or Opposing Application for Order and/or Assessment of Costs
Complete this form in response to an Application for Order and/or Assessment of Costs.
Arbitration Order for Joinder of Party
Complete this form to give notice of an arbitrator’s order that another person be joined as a party to the proceedings.
A party to a dispute in the Workers Compensation Arbitration Service may appeal to the District Court of Western Australia against a decision of an Arbitrator. In any other case, leave to appeal may be granted where a question of law is involved.
An appeal to the District Court must be made within 28 days from when the Arbitrator provides the parties with the written reasons for the determination.
The District Court may affirm, vary, quash, substitute or make an addition to the original Arbitrator decision.
Accessing previous decisions
The jurisdiction or authority that deals with appeals depends upon when the appeal was made.
December 2011 - presentAppeals from the Workers Compensation Arbitration Service have been heard by the District Court of Western Australia. These decisions can be accessed via the eCourts portal.
Previous decisions of the Commissioner and Compensation Magistrate can now be accessed via WorkCover WA Online. Information about how to register for WorkCover WA Online can be found here.
November 2005 – November 2011
The Commissioner dealt with matters regarding:
- a novel or complex question of law referred by an arbitrator
- a question of law referred by a party to the proceeding before an arbitrator
- appeals against a decision of an arbitrator.
1994 – November 2005
The Compensation Magistrate dealt with:
- a novel or complex question of law referred by a review officer
- a question of law referred by a party to the proceeding before a review officer
- appeals against a decision of a review officer.
Poster (General) – Have you been injured at work?
Poster (Workplace) – Have you been injured at work?
Brochure – Have you been injured at work?
Fact Sheet – Who is WorkCover WA?
This fact sheet outlines the role of WorkCover WA in the workers compensation and injury management scheme.
WorkCover WA Fact Sheet-Employer Essentials – Chinese Simplified
WorkCover WA – Guide for Workers – Chinese Simplified
WorkCover WA – Guide for Employers– Chinese Simplified
WorkCover WA Fact Sheet-Silicosis – Chinese Simplified
WorkCover WA Uninsured Claims Fact Sheet – Chinese Simplified
WorkCover WA Fact Sheet-Employer Essentials – Chinese Traditional
WorkCover WA Fact Sheet-Employer Essentials – Tagalog
WorkCover WA – Guide for Workers – Tagalog
WorkCover WA – Guide for Employers– Tagalog
WorkCover WA Fact Sheet-Employer Essentials – Vietnamese
