Can You Claim WorkCover for an Old Injury?

WorkCover claims for an old injury in Qld raise a lot of questions, particularly in regard to whether compensation is possible.

WorkCover lawyers on the Gold Coast are well-versed in WorkCover matters, especially where old-injury claims are disputed or challenged. WorkCover in Queensland (Qld) covers both new injuries and pre-existing injuries or conditions that have been aggravated, exacerbated, accelerated or deteriorated by work-related duties and tasks.

Our team of personal injury lawyers on the Gold Coast has put together this article to clarify the conditions under which pre-existing injuries are eligible for WorkCover.

 

What Counts As a Pre-Existing Injury Under Queensland WorkCover Laws?

The Workers’ Compensation and Rehabilitation Act 2003 (Qld), Section 571A, defines a pre-existing or old injury/condition as any injury, illness or medical condition that has been aggravated by employment. The primary focus is looking at whether employment caused a compensable aggravation, rather than the mere existence of a pre-existing injury.

Another way to look at pre-existing conditions: they are medical conditions or injuries that exist during a period of employment and have been, as someone would reasonably suspect, aggravated by work duties.

Case Study: Hoby v Workers’ Compensation Regulator [2018] QIRC 021

In this case, a worker’s shoulder condition had developed gradually against a backdrop of pre-existing degeneration, and the medical evidence was contested. The Commission had to determine whether the employment was a significant contributing factor to the injury, drawing a line between cases where work merely “irritated” an underlying condition and cases where it genuinely drove the injury’s development. The case is a good demonstration that an old or degenerative condition won’t automatically sink a claim, but the worker still has to show the employment did more than aggravate something that was going to cause problems regardless.

 

Old Injury vs Aggravated Injury: What is the Difference?

Understanding the difference between a recurring injury (old-injury flare-up) and one that has been aggravated or worsened during work is critical under WorkCover legislation. Where there is a recurrence injury, WorkCover usually reopens a previously accepted claim.

However, an aggravation acts as a new injury matter triggered by a definable workplace activity or incident.

For WorkCover to see a pre-existing injury as compensable, the old condition must be temporarily aggravated or worsened as a result of employment. Work must be a significant contributing factor to this flare-up. 

 

Can You Claim Workers’ Compensation for an Old Injury?

Having an old injury doesn’t automatically disqualify you from WorkCover. You can claim compensation for an old injury through WorkCover in Qld if a recent workplace event or current work duties have significantly worsened, aggravated or exacerbated the condition.

Under WorkCover, work activity must be a significant contributing factor to the cause of a current flare-up or change, and cannot be claimed if work only has a small impact.

 

Can You Claim WorkCover for the Same Injury Twice?

In Qld, you may be eligible to receive workers’ compensation for the same injury (both physical and psychological) twice under specific circumstances. The recurrence of an existing, compensable injury may be dealt with under the original claim, whereas a new incident or employment-related aggravation may give rise to a new claim.

Whether it is a recurrence or a new injury depends on the particular facts and medical evidence. Speak to a personal injury lawyer in Qld about legal regulations and how to identify whether the aggravation is considered new or old.

Case Study: Barra-Padilla v Workers’ Compensation Regulator [2014] QIRC 106

This issue addressed in this case was the question of whether a later workplace episode was a new, discrete injury or simply a continuation of an earlier accepted workplace injury. The distinction matters because it determines whether the worker is pursuing a fresh claim or is still within the scope of the original one, and it shows that “claiming twice” isn’t really the right way to think about it. The real question the Commission has to answer is whether what’s happening now is a new injury in its own right, or the ongoing effect of something already on the books.

 

What Evidence Do You Need for an Old Injury WorkCover Claim?

Proving that the flare-up of a pre-existing injury was caused by work can be significantly harder than what is required for a new injury. It involves more complex pathways and will require significant, clear proof to suggest that work was a significant contributing factor to the worsening of symptoms.

 

Medical Evidence

• Certificate of Capacity: A form from your treating doctor that diagnoses your current symptoms and states how work caused the change.
• Doctor Clinical Notes: Past and current records from your GP or specialists showing your baseline health before and after the recent work incident.
• Old and New Imaging: Scans or X-rays from when the injury first happened compared to recent scans showing new damage or worsening.

 

Employment & Incident Details

• Task Details: A written description of the exact work tasks, heavy lifting, or repetitive movements that made the old injury worse.
• Before-and-After History: Proof that you were able to do your job at full capacity before the recent event changed your ability to work.
• Witness Statements: Notes or short statements from co-workers or bosses who saw the event or saw you struggling with pain at work.

 

Will a WorkCover Claim for a Previous Injury be Impacted if an Employer Disputes it? 

As is the case with most legal matters, disputes are not uncommon, particularly where payouts are in contention. Employers can dispute a WorkCover claim with the right grounds and enough supporting evidence.

An employer disputing a claim does not automatically stop a worker’s payments. WorkCover Queensland makes the relevant decision, and payments may only be stopped, suspended or varied where WorkCover makes a decision affecting the worker’s entitlement. This may mean the claim is delayed, paused or fully rejected if WorkCover decides in favour of the employer’s dispute evidence.

Seeking the support of a WorkCover lawyer in Queensland can help you better understand these matters and your legal rights.

 

Steps-by-Step Guide: Workers’ Compensation for Pre-Existing Condition in QLD

WorkCover in Qld handles pre-existing injury compensation claims with the same process as new injury claims. This involves the injured person (worker) lodging their claim with WorkCover, following the steps below:

• Report the aggravated/exacerbated injury to the employer (Incident Report)

File an Incident Report with the employer about the aggravated injury, including details about what worsened the condition (this is necessary for WorkCover). 

• See a doctor/specialist (Work Capacity Certificate)

Visit a GP or specialist for care advice and a Work Capacity Certificate, making sure to explain details about the old injury and what caused the aggravation.

• Gather medical evidence

Collect all past and present medical notes, imaging (x-rays, MRI etc.), and specialist reports 

• Lodge the claim

Submit a claim online through WorkCover QLD, making sure to include the Incident Report and Work Capacity Certificate (as well as supporting evidence)  

In Queensland, a WorkCover statutory claim generally needs to be lodged within six months of the injury. Where the injury is a gradual process or involves aggravation of a pre-existing condition, identifying the relevant date can be more complicated. Workers should lodge their claim as soon as possible.

 

Common Myths: Previous Injury and Workers’ Compensation Claim

It’s not uncommon for misconceptions to arise online regarding legal matters, especially where people have faced rejected claims due to improper lodgement processes. However, it’s important to consider the correct legal information regarding WorkCover claims before lodging or deciding, for yourself, whether or not you’re eligible for workers’ compensation.

 

An Old Injury Means Your Claim Will Automatically be Rejected

This is incorrect: an old injury does not automatically mean a claim will be rejected. While the process is more strict and involves more careful assessment of conditions, a worker can still receive compensation if an old injury is aggravated or exacerbated by work-related activities or duties.

 

Only New Injuries are Covered by WorkCover

Again, WorkCover supports both new and old injuries under circumstances where employment was a significant contributing factor. Instances where WorkCover may reject a claim for an old injury include:

• No clear work causation

• The aggravation has stopped (was temporary)

• Late reporting

• Insufficient medical proof

 

Case Study: Tapp v Workers’ Compensation Regulator [2015] QIRC 135 

This case involved a workplace fall against a background of significant pre-existing degenerative spinal disease. The Commission’s task was to determine whether the fall was genuinely a significant contributing factor to the injury, rather than simply the occasion on which a pre-existing condition happened to become symptomatic. It’s a useful example precisely because it doesn’t turn on whether an old injury can ever be claimed, but on how much work-related contribution is actually needed once a pre-existing condition is in the picture. 

 

When Should You Seek Legal Advice for an Old Injury Workcover Claim?

Seeking legal advice can be a choice in matters where legal complexities become overwhelming or where disputes progress to the courts. However, seeking legal advice in regard to WorkCover claims can streamline the process from the very beginning. This ensures you have everything you need, from the right documentation to enough evidence to support your workers’ compensation claim.

Our team at Claimwise is experienced in handling workers’ compensation claims. We support those trying to navigate the claims process, as well as representing workers in matters where their claims are disputed. Speak with us today to see how we can support you and your claim matter.

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*This article provides general information about WorkCover in Queensland. It is not legal advice and should not be relied on as a substitute for advice from a qualified legal practitioner about your specific circumstances.