Dr Martin Russell

WorkCover psychological claim Adelaide

FAQ: Should I start a WorkCover psychological injury claim in Adelaide?

1. How are psychological injury claims different from other claims?

Under the RTWSA legislation, psychological injury claims are assessed differently from physical injury claims.

For many physical injuries, the key question is whether employment was a significant contributing cause.

For a psychological or psychiatric injury in South Australia, employment needs to be “the significant contributing cause” — meaning the most significant contributing cause, not necessarily the only cause  (SA Law Handbook)

Also, the claim must also not arise wholly or predominantly from “reasonable management action carried out in a reasonable manner”. (South Australian Legislation)

These mean that a claim would not be accepted for reasonable disciplinary action, transfer, demotion, dismissal, or administrative action, as long as it was carried out in a reasonable way.

Often parties will disagree on these matters.

This means that psychological claims will often be more complex, more disputed, and take longer to determine.

2. What is the difference between primary and secondary/consequential psychological injury?

A primary psychological injury is where the psychological injury itself is the main injury being claimed.

For example:

  • anxiety after bullying or harassment;
  • depression after prolonged unsafe workload;
  • PTSD after traumatic workplace exposure;
  • adjustment disorder after serious workplace conflict;
  • psychological injury related to workplace violence, discrimination, or unsafe psychosocial conditions.

A secondary or consequential psychological injury usually means the person first had a physical injury, and then developed psychological symptoms during the management of that injury — for example, depression after pain, disability, loss of work, isolation, financial stress, or the stress of a physical injury claim. (rtwsa.com)

[NOTE: My practice is only for primary RTWSA psychological injury claims, not physical injury claims where anxiety or depression has developed secondarily.]

3. Can I claim if I already had anxiety or depression or some other psychological issue?

Possibly.

A previous mental health condition does not automatically prevent a RTWSA psychological injury claim. The important questions are usually:

  • Did work cause a new psychological injury?
  • Did work significantly worsen, aggravate, accelerate, or reactivate a previous condition?
  • What changed after the workplace events?
  • Was employment still the significant contributing cause of the current injury or deterioration?

The Return to Work Act includes aggravation, acceleration, exacerbation, deterioration, or recurrence of a prior injury, but for psychiatric injury, employment still needs to be the significant contributing cause of that change. (South Australian Legislation)

So the issue is not simply:

“Have you ever had anxiety or depression before?”

The better question is:

“What changed, when did it change, and what role did work play?”

4. What if I kept working and looked like I was coping?

Keeping working does not automatically mean you were well.

Many people keep working while deteriorating privately. They may still attend work, answer emails, meet deadlines, or appear calm, while also experiencing:

  • poor sleep;
  • panic;
  • rumination;
  • dread before work;
  • irritability;
  • tearfulness;
  • avoidance;
  • reduced concentration;
  • increased alcohol or medication use;
  • loss of confidence;
  • worsening depression or anxiety.

RTWSA’s psychological injury guide notes that psychological injuries are often “invisible” and can affect thinking, organisation, planning, social interaction, emotions, physical symptoms, and function. (rtwsa.com)

That said, if you kept working, the claim may still need a clear explanation of:

  • what symptoms you had;
  • when they began;
  • what treatment you sought;
  • why you continued working;
  • what changed over time.

5. Will a claim help me get X outcome?

This is one of the most important questions.

Before starting a RTWSA psychological injury claim, it helps to ask:

What am I hoping this claim will actually do?

A claim may help with:

  • treatment funding;
  • income support if you cannot work;
  • return-to-work planning (or ultimately alternative work options);
  • safer duties or workplace adjustments;
  • formal recognition that an injury may be work-related;
  • involvement of a claims agent or return-to-work process.

But a RTWSA claim is not mainly:

  • an apology process;
  • a bullying investigation;
  • an unfair dismissal claim;
  • a whistleblower process;
  • a disciplinary process against your manager;
  • a guarantee that the workplace will change;
  • a guarantee that you will be accepted for income support and assistance.

It’s important that you understand the limitations of RTWSA, because you may need other assistance for things that RTWSA can not do.

6. Can I lodge a claim later?

Possibly, but you should not let things drift.

RTWSA says that if you have been injured or become ill because of work, you should let your employer know, see a doctor, and ask for a Work Capacity Certificate if you have lost time from work. RTWSA also says you can start a work injury claim before obtaining a Work Capacity Certificate, but you will need the certificate when submitting the claim. (rtwsa.com)

The Legal Services Commission of SA says a worker should notify their employer as soon as practicable, within 24 hours if possible, and that a claim should generally be made within 6 months of the entitlement arising. Delay may not prevent a claim in some circumstances, but it can create problems with evidence and investigation. (Law Handbook)

So the practical answer is:

  • you may be able to claim later;
  • but timing, medical records, notification, and evidence matter;
  • if you are unsure, speak to your GP, and consider legal, union, or worker advice early.

7. How can I avoid a psychological claim?

A RTWSA claim is one option. It is not the only option.

Remember to make sure you are clear with others, such as colleagues, managers, HR, preferably in writing, that you are having issues. It’s even more important to follow up, if those issues are then not being sufficiently resolved over time.

Other options may include one or more of:

  • taking sick leave;
  • using annual leave to have a break;
  • seeing your usual GP for mental health support;
  • getting a Mental Health Treatment Plan;
  • seeing a psychologist or counsellor;
  • using Employee Assistance Program (EAP) or similar, if available at your workplace;
  • speaking with HR;
  • asking for workplace adjustments;
  • speaking with your union, or an alternative union advisory service;
  • getting worker advice or legal advice;
  • using an internal grievance or bullying process;
  • changing teams, duties, hours, or reporting lines;
  • and ultimately, leaving and finding another job.

Even a RTWSA claim will still end up having to address many of these same issues, with many of these same choices.

8. How do I start a RTWSA psychological injury claim?

The usual steps are:

  • tell your employer you believe you have a work-related injury or illness;
  • see a doctor;
  • ask for a Work Capacity Certificate;
  • the employer can lodge the claim online;
  • if the employer cannot or will not lodge it, or you don’t want to go through your employer, you can contact the claims agent directly. This link will help you know which claims agent you can use – https://www.rtwsa.com/insurance/insurance-with-us/claims-agent-lookup – including whether an organisation is self-insured for RTWSA purposes)

 

9. What can I expect with a psychological claim?

A psychological injury claim is often more involved than a physical injury claim.

You can expect that the claims agent may gather information from:

  • you;
  • your employer;
  • relevant parties to the issues;
  • workplace records;
  • witnesses;
  • your treating GP;
  • your treating psychologist and/or psychiatrist. (com)

Often this means that an independent assessor will be engaged to take a comprehensive statement from you.

This is where it can be important to have written down your thoughts, collected records such as emails, texts, paper documents etc, and have taken some time to get them into a timeline of events.

Usually there will also be an independent medical examination (IME) with a psychiatrist who will assess the medical situation.

With all this complexity and information to formally gather, it is not surprising that most claims are not able to be determined quickly.

If a claim takes longer than 10 working days to be decided, you will be offered interim benefits for either income support, or medical expenses, or both. You will be told that if the claim is rejected you will be asked to repay these costs.

 

10. How can I manage when I have to wait so long for a claim to be determined?

You are likely to be offered interim payments if the claim takes longer than 10 business days, noting those payments may be recoverable if the claim is rejected. (rtwsa.com)

There are also some medical services that may be provided on a non-recoverable basis, ie you won’t be required to pay them back even if the claim is rejected. These may include some medical fees, case conference fees, counselling/psychology appointments, low intensity mental health support, exercise physiologist visits, so you can ask about these with the person managing your claim.

11. Why might I decide NOT to start a psychological claim?

You might decide not to start a claim if another pathway is safer, simpler, or more likely to achieve what you need.

Reasons might include:

  • you are improving with GP care, sick leave, psychology, or workplace changes;
  • you mainly need legal or industrial advice rather than medical certification;
  • you want to resolve the issue internally first;
  • you are planning to leave and do not want to enter a formal claim process;
  • the likely claim issues involve reasonable management action done in a reasonable manner;
  • you are concerned the claim process itself may worsen your stress;
  • you are worried about the stigma of having a “workcover” claim on your record.

This does not mean doing nothing. If work is affecting your mental health, it is still wise to get medical support, document what happened, and understand your options.

 

12. Is this more than stress — do I have a diagnosable psychological injury?

This is central.

RTWSA’s FAQ says eligibility includes having a diagnosed injury or illness, and specifically notes that stress is not a diagnosis. (rtwsa.com)

That does not mean stress is trivial. Stress can be severe, disabling, and a warning sign that something is wrong. But for a psychological injury claim, a doctor usually needs to assess whether there is a diagnosable condition such as:

  • adjustment disorder;
  • major depression;
  • anxiety disorder;
  • PTSD;
  • acute stress disorder;
  • another recognised mental health condition.

A GP assessment should consider:

  • symptoms;
  • duration;
  • severity;
  • sleep;
  • risk and safety;
  • function;
  • work capacity;
  • other contributing factors;
  • treatment needs.

If you are feeling suicidal, unsafe, or unable to cope, seek urgent help first — through your GP, local emergency department, 000 in an emergency, or crisis support services.

 

13. What should I do before deciding whether to start a claim?

Before deciding, try to do these things:

  • See your GP and explain clearly that you think work may be affecting your mental health.
  • Write a timeline of what happened, with dates if possible.
  • Keep documents such as emails, rosters, texts, meeting notes, performance documents, warnings, complaints, and HR responses.
  • Record symptoms: sleep, mood, anxiety, panic, anger, rumination, avoidance, concentration, function.
  • Think about what outcome you want: treatment, income support, workplace change, time away, legal advice, or leaving.
  • Consider advice from a union, worker advice service, or lawyer if dismissal, bullying, discrimination, performance management, or disciplinary action is involved.
  • Avoid long reactive emails while distressed. Short, factual records are usually safer and more useful.
  • Consider whether it is safe to notify HR that your health is being affected and you have sought medical advice.

RTWSA says claims agents determine psychological claims using information from the injured worker, employer, and treating doctor, and sometimes further medical reporting is required. (rtwsa.com)

14. I’m still not sure. Who can I talk to about this?

That is very common.

You may need more than one type of advice, because this can involve medical, workplace, legal, and financial issues.

You could speak with:

  • your union — if you are a member;
  • SA Unions Workers’ Compensation Service — which describes itself as providing free dispute resolution, advice, and advocacy services to eligible workers; (SA Unions)
  • Legal Services Commission SA — for preliminary legal information, advice, and referrals; (Legal Services Commission)
  • a private workers compensation or employment lawyer — especially if dismissal, discrimination, bullying, adverse action, or disputed management action is involved;
  • RTWSA or the claims agent — for process information;
  • EAP — for short-term support if available.
  • your GP — for diagnosis, treatment, safety, risk, capacity, and certificates;
  • a psychologist or psychiatrist — for assessment and treatment;

A good first question is:

“Am I trying to answer a medical question, a workplace question, a legal question, or all three?”

That helps you choose the right person to speak to next.

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