When Does a WorkCover Dispute End Up in the Magistrates Court?

You’ve lodged your WorkCover claim, but your insurer has rejected it or made a decision you don’t agree with. Now you’re wondering: can an employer dispute a WorkCover claim, and will this end up in court?

Here’s the reality. Your dispute reaches the Magistrates Court only after you’ve exhausted earlier steps – specifically, after conciliation fails and you receive a Genuine Dispute Certificate. Most WorkCover disputes in Victoria never make it to court because they are resolved at conciliation or through alternative pathways.

But when they do reach the Magistrates Court, you need to understand what that means for your timeline, your rights, and your claim.

Key Insights

• WorkCover disputes reach the Magistrates Court after conciliation fails and a Genuine Dispute Certificate is issued.
• Employers can challenge claims, but only WorkCover insurers make acceptance or rejection decisions.
• The process from claim rejection to court hearing typically takes 6-12 months.
• You have alternative options, including WCIRS reviews, arbitration, and Medical Panel referrals.
• Legal representation significantly improves your chances of a successful outcome.

Can an Employer Dispute a WorkCover Claim?

Yes, but here’s what that actually means in practice.

Many injured workers worry when they hear their employer dispute their claim. The crucial thing to understand is this: your employer cannot reject your WorkCover claim outright. That power sits solely with the WorkCover insurer (also called WorkSafe Agents).

When you lodge a claim, your employer must forward it to their insurer within 10 days, even if they completely disagree with it. Can an employer dispute a WorkCover claim? Absolutely – but they can only provide information and evidence to the insurer supporting their concerns. The insurer then investigates and makes the final decision about whether to accept or reject your claim.

Common reasons an employer might dispute a WorkCover claim include:

• Disagreement about how the injury occurred
• Questioning whether the injury is work-related
• Believing the injury was pre-existing
• Disputing the timing or circumstances of the reported injury
• Claiming you’re not actually a “worker” under the legislation (for example, if you’re a contractor)

If your employer raises concerns, expect the insurer to conduct a circumstance investigation. This might involve statements from you, your employer, and witnesses, plus a review of incident reports and workplace records.

The Path to Magistrates Court: Step by Step

WorkCover disputes don’t jump straight to court. Victoria’s system requires you to follow a structured dispute resolution process.

Step 1: Claim Decision (28 Days)

After you lodge your claim, the WorkCover insurer has 28 calendar days to investigate and decide whether to accept or reject it. For mental injury claims, they must notify you about provisional payments within 3 business days. During this period, they might arrange independent medical examinations or request additional information.

Step 2: Conciliation (60-Day Window)

If the insurer rejects your claim or makes another decision you disagree with, you have 60 days to lodge an application for conciliation with the Workplace Injury Commission (WIC). Conciliation is an informal meeting where a conciliation officer helps you and the insurer try to resolve the dispute.

At conciliation, several outcomes are possible:

• The insurer might accept your claim
• You might reach a partial settlement
• The conciliation officer might refer medical questions to the Medical Panel
• The conciliation officer might direct the insurer to make payments
• If resolution fails, you’ll receive a Genuine Dispute Certificate

Step 3: Genuine Dispute Certificate

This certificate is your ticket to the Magistrates Court. It confirms that conciliation hasn’t resolved the matter and you’re now entitled to start court proceedings. You must receive this certificate before the Magistrates Court can hear your case.

Step 4: Magistrates Court Proceedings

Once you have your Genuine Dispute Certificate, you (or more realistically, your WorkCover solicitors) can file a statement of claim with the Magistrates Court WorkCover Division. This document summarises your injury, how it occurred, and what relief you’re seeking.

The Magistrates Court can make binding decisions about:

• Whether your claim should have been accepted
• Whether weekly payments or medical expenses should be paid
• Setting aside insurer decisions
• Ordering compensation payments
• Awarding costs and interest

If either party disagrees with the Magistrates Court decision, they have 30 days to appeal to the Supreme Court, but appeals require leave (permission) and can only challenge legal errors, not factual findings.

How Long Does a WorkCover Claim Take in Victoria?

For straightforward accepted claims:

• Initial decision: 28 days
• First payment: Within 7 days of acceptance

For disputed claims that proceed to Magistrates Court:

• Conciliation: Usually 2-3 months from application
• From Genuine Dispute Certificate to court hearing: Minimum 6 months, often 9-12 months
• Total timeline from claim rejection to court decision: 8-15 months typically

These timelines explain why many injured workers and insurers prefer to settle disputes before court. The delay creates financial pressure, especially if you’re not receiving weekly payments during the dispute.

Factors affecting how long a WorkCover claim takes in Victoria include:

• Complexity of your injury and medical evidence
• Whether investigations are needed
• Court scheduling and backlog
• Whether you have legal representation preparing your case efficiently

Understanding Your Employment Rights During Disputes

One critical concern for injured workers is job security during long disputes, especially regarding terminating employment after 130 weeks WorkCover.

The 52-Week Employment Obligation Period

Your employer must keep your pre-injury job open for 52 weeks of weekly payments. During this period, they’re required to offer suitable duties within your medical restrictions. They cannot terminate your employment solely because of your injury or WorkCover claim.

After 52 weeks, if you still can’t perform your pre-injury duties, your employer can consider termination, but they must follow fair procedures to avoid unfair dismissal claims.

The 130-Week Payment Threshold

This is different from the 52-week employment obligation. You’re entitled to weekly payments for up to 130 weeks (2.5 years) if you can’t return to your pre-injury hours. Understanding the rules around terminating employment after 130 weeks WorkCover is crucial because:

• After 130 weeks, weekly payments only continue if you have no current work capacity that’s likely to continue indefinitely.
• For claims reaching 130 weeks after 31 March 2024, you must also have a 21% or greater whole person impairment rating.
• Your employer can terminate employment after the 52-week obligation period ends, even if you’re still receiving weekly payments.

IMPORTANT NOTE: Terminating employment after 130 weeks WorkCover doesn’t automatically end your entitlement to benefits. Your WorkCover rights continue regardless of employment status, and you may still be entitled to medical expenses, impairment benefits, and potentially a common law claim.

Expert Support For WorkCover Disputes

The difference between understanding the WorkCover claims process in Victoria and actually navigating a complex dispute can be significant. If you’re considering whether to proceed to Magistrates Court or explore alternative options, professional guidance makes all the difference.

Whether you’re dealing with a rejected claim, terminated payments, or concerns about terminating employment after 130 weeks WorkCover, understanding the process and your options gives you the confidence to make informed decisions about your next steps.

At Henry Carus + Associates we’ve guided hundreds of Victorian workers through the dispute resolution process, from conciliation to Magistrates Court. Our WorkCover solicitors know how to build strong cases, negotiate effectively, and achieve fair outcomes without unnecessary delays. We work on a no-win, no-fee basis, so you have nothing to lose by getting expert advice.