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.
