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Use this form to send information to
WorkCover Queensland.
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I would like to send or request
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A legal invoice
A Provider Management Plan
A Work Capacity Certificate or medical report
An invoice
Information on a new claim
Information on an existing claim
Other information
Send a receipt for reimbursement
Third party privacy undertaking - insurer
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Information details
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Advice or instructions
Allied Health Report
Amended Settlement Documents
Application against WorkCover
Application for a lung disease examination
Centrelink Clearance / Recovery
Centrelink General Request
Centrelink Notice
Centrelink Prelim Notice
Centrelink Report Request
Claim an expense (receipt)
Clearance or charge
Common law claim information
Copy of a claim
Decision about the degree of permananent impairment (NOA)
Employer report
Factual report
IME Report
Invoice
Invoice & Medical Certificate
Invoice (legal)
Law Practice Certificate
Legal information
Legal Panel Invoice
Medical report
New claim
Notice of Claim
Other document
Other document
Payment Direction/Trust Account Authority
Permanent Impairment assessment
Privacy Undertaking form for an employer
Private Hospital specialised program request
Provider Management Plan
Radiology Report
Record Purposes Only (reportable injuries)
Register or update provider details
Regulator Appeal Unit file request - (claims)
Regulator MAT document
Regulator review unit file request
Regulator review/appeal decision action required (claim)
Regulator review/appeal decision no action required (claims)
Regulator Review/Appeals - policy info/review request
Request a copy of a claim
Request a copy of application
RTW Services Report
S544 - request for additional info
Secure legal advice
Send a receipt for reimbursement
Send a Work Capacity Certificate
Send a Work Capacity Certificate
Settlement monies
Submit partial wages
Submit wage information
Suitable Duties Plan
Suitable duties progress update
Surgery approval
Surveillance report
Tax declaration form
Update policy information
Urgent Notice of Claim
Work Capacity Certificate (existing claim)
Work Capacity Certificate (multiple claims)
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Claim number
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Email address
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Relationship to claim
Claimant
Claimant solicitor
Employer
Other
Provider
Solicitor Panel
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Details
Attachments
Acknowledgement
In using this online facility you acknowledge:
the information and documents provided will form part of the records of the claim you have specified (only attach relevant documents)
the information provided and documents submitted are true and correct
your obligations under the
Workers Compensation and Rehabilitation Act 2003 and Regulations
any personal information about you or others has been provided with consent and will be collected, stored, and disclosed in accordance with our
Privacy and Security Statement
and
Privacy Policy
.
Acknowledgement
In using this online facility you acknowledge:
the information provided and documents submitted are true and correct
your obligations under the
Workers Compensation and Rehabilitation Act 2003 and Regulations
any personal information about you or others provided will be collected, stored, and disclosed in accordance with our
Privacy and Security Statement
and
Privacy Policy
.
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