Comcare claims and psychological injury: what employees should know

If you work for the Australian Government or a company that self-insures under the Comcare scheme, a work-related mental health condition is covered by federal law rather than your state scheme. Comcare psychological injury claims have their own tests, timeframes and review steps.

This article explains those rules in plain English and where psychological and neuropsychological assessments fit, from treatment planning to independent reviews.

Who the Comcare scheme covers

The Comcare scheme runs under the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act). Comcare says the scheme covers employees of:

• the Australian Government
• Australian Government authorities and corporations
• corporations that hold a licence to self-insure under the SRC Act

If you work for a state government or most private employers, your state or territory scheme applies instead. Current and former Australian Defence Force members usually claim through the Department of Veterans’ Affairs. Our article on DVA and veterans’ assessments covers that system.

Making a claim

Comcare’s guide to making a claim explains that you complete a claim form and give it to your employer’s human resources area, which sends it on for processing. You also need a medical certificate from a medical practitioner, such as your GP or a psychiatrist. The certificate should include:

• a diagnosis of the condition you are claiming for
• what caused it, and the date of injury
• your fitness for work
• recommended treatment

Under regulations that started on 1 April 2024, Comcare has 20 calendar days to decide a claim for an injury and 60 calendar days to decide a claim for a disease. Psychological conditions are often treated as diseases, so a decision may take longer. If money is tight while you wait, Comcare suggests checking whether Centrelink or income protection insurance could help.

While you wait for a decision

Waiting can be stressful, and stress can make symptoms worse. Things that often help include:

• keeping regular appointments with your GP and starting treatment early
• keeping a steady daily routine for sleep, meals and some physical activity
• staying in touch with supportive people, at work and outside it
• keeping copies of forms, certificates, emails and notes of phone calls
• asking your claims manager to explain anything you do not understand

How psychological injury claims are decided

Comcare explains how a claim is assessed. The claims manager checks three things: that you are an employee under the SRC Act, that you have an injury or disease as the Act defines it, and that it has caused incapacity, impairment or death. Decisions are made on the balance of probabilities, which means more likely than not.

Significant contribution from work

For a condition treated as a disease, your employment must have contributed to it to a significant degree. Other things in your life can also have played a part. The question is whether work made a significant contribution.

The reasonable administrative action exclusion

You cannot receive compensation for a condition caused by reasonable administrative action taken in a reasonable manner. Comcare gives examples such as a reasonable appraisal of your performance and reasonable counselling action, whether formal or informal. The words “reasonable” and “reasonable manner” matter. An action that was unreasonable, or carried out in an unreasonable way, may not be excluded.

Who decides

Comcare notes that medical professionals do not decide whether a claim is accepted. Your claims manager does, based on all the evidence. The claims manager also checks that the history behind your diagnosis matches the information in your claim, so it helps to give your doctor and psychologist an accurate, consistent account.

Recent changes you should know about

Comcare’s page on amendments to the SRC Act lists several changes from 2024:

• PTSD presumption: for first responders and other declared classes of employees, post-traumatic stress disorder is presumed to have been contributed to, to a significant degree, by employment.
• Medical examinations: Comcare must follow a guide for arranging rehabilitation assessments and medical examinations. It includes limiting how many examinations can be required and taking your views into account when choosing the examiner. A request to attend a medical examination can now be reviewed.
• Decision timeframes: the 20 and 60 calendar day periods described above.

Where assessments fit

Treating assessments

A treating psychologist assesses your symptoms, how they affect daily life and work, and what treatment is likely to help. Their reports can support your GP’s certificates and your return to work plan. Treatment usually focuses on reducing symptoms, building coping skills and planning a safe, gradual return to work. Good communication between you, your doctor, your psychologist and your workplace makes this easier.

Neuropsychological assessments

Some people with depression, anxiety or trauma notice problems with memory, focus or thinking speed. A neuropsychological assessment measures these skills in detail and looks at likely causes. It can guide practical workplace adjustments, such as written instructions or a graded return to full duties. It is also useful when there has been a head injury at work, or when thinking problems continue after mood symptoms have improved. The results can reassure you about skills that are working well, as well as pointing to areas that need support.

Medical examinations

Comcare or a licensee can ask you to attend a medical examination with an independent practitioner. Our guide to independent medical examinations explains what happens and what your rights are.

Medico-legal reports

If a decision goes to review, your lawyer may ask for an independent psychological or neuropsychological report. The assessor’s duty is to give an impartial opinion.

If you disagree with a decision

1. Ask for a reconsideration. Comcare says you have 30 days from receiving the determination to ask, or you need to apply for an extension.
2. Apply to the Administrative Review Tribunal (ART). The ART replaced the Administrative Appeals Tribunal on 14 October 2024. The time limit to apply to the ART is 60 days after you are given notice of the reconsideration decision. You do not need a lawyer, although the other party may have one.

Permanent impairment and non-economic loss payments may also be available for lasting effects. Comcare’s website explains the rules.

Invictus Health कैसे मदद कर सकता है

Our psychologists and counsellors offer depression counselling and other support in person in Preston or by telehealth across Australia. Our neuropsychologists provide neuropsychological assessments, and we prepare independent medico-legal assessments. Neuropsychology reports are reviewed by Dr Judy Tang OAM.

For employers, our workplace programs include Mental Health First Aid and resilience workshops. For Comcare funding, check with your claims manager before booking. You are welcome to contact us with questions.

This article is general information, not legal advice. Speak with your doctor, your claims manager or a lawyer about your situation. If you are in danger, call 000. For 24-hour crisis support call Lifeline on 13 11 14.