How WorkCover Queensland decides a psychological injury claim
A GP diagnosis and work capacity certificate, a claim lodged within 6 months, and then an insurer decision measured against sections 32 and 32(5). Here is the sequence in order.
The starting point for most claimants is a GP visit. WorkCover Queensland's own worker guidance describes the first step as seeing a GP, who can do a mental health assessment, discuss treatment options, provide a work capacity certificate, and refer the worker to a mental health professional for further treatment if needed. The work capacity certificate confirming a mental injury diagnosis is what a claim needs to proceed.
Lodging, and what the insurer then checks
The claim has to be lodged within 6 months of the entitlement to compensation arising, under s 131. From there, the insurer, WorkCover Queensland for most employers, or a licensed self-insurer for a smaller number of employers, decides whether the injury meets the s 32 test (employment as a significant contributing factor) and whether any part of the s 32(5) reasonable management action exclusion applies. Neither of these questions has a fixed timeline set out in the sources this site has checked, and the insurer's decision is communicated in writing.
If the claim is accepted, or if it is not
An accepted claim moves into treatment funding (the next few guides cover what is funded and how) and, where the incapacity continues, weekly payments under the step-down structure in sections 150 and 151. A rejected claim can be challenged through the review process within 3 months of the written decision. WorkCover Queensland's own guidance notes that if a mental injury claim is not accepted, WorkCover will not continue to pay for treatment already provided during the assessment period, but the worker does not have to pay those interim costs back.