Australian Government Claim For Workers' Compensation printable pdf download

CLAIM FOR WORKERS’

COMPENSATION

Seafarers Rehabilitation and Compensation Act 1992

Information about claiming workers’

information in accordance with the Privacy Act 1988. The

Seacare Authority collects information from the employer

compensation

about workers’ compensation claims made under the

Seafarers Act in order to maintain a database of Seacare

In this document, all references to ‘the employer’ mean the

scheme workers’ compensation statistics. In addition, in

employer against whom this claim is made.

some cases the Seacare Authority manages claims against

Please complete this form if you want to claim workers’

the Seafarers Safety Net Fund. For these purposes, and for

compensation under the Seafarers Rehabilitation and

other purposes related to the Seacare Authority’s functions

Compensation Act 1992 (Seafarers Act). This form is

under the Seafarers Act, the Seacare Authority may use or

approved by the Seafarers Safety, Rehabilitation and

disclose your personal information to bodies and agencies

including (but not limited to):

Compensation Authority (Seacare Authority) in accordance

with subsection 63(2) of the Seafarers Act.

• the employer

• the employer’s insurer

The Seacare Authority produces guidance material to

assist employees and employers understand their rights

• an approved rehabilitation program provider

and obligations regarding workers’ compensation and

• government agencies including Centrelink, the

rehabilitation. Copies of these information brochures

Australian Taxation Office, the Department of

and booklets are available from the employer or from the

Employment, Comcare and Safe Work Australia

Seacare Authority website at

• any external third party that the Seacare Authority

If you wish to claim for permanent impairment and non-

contacts to carry out statutory functions

economic loss or compensation for dependants of

• courts and tribunals

deceased employees, separate forms are available from

• any other person where there is an obligation under

the employer, or from the Seacare Authority.

law to do so.

Note: If you intend to make a claim for compensation

We want to ensure that your personal information that is

against more than one employer in relation to the same

collected, used, stored or disclosed is accurate, up-to-

injury or illness, you must provide a notice to each

date and complete. The Seacare Authority’s Privacy Policy

employer stating the name and address of each employer.

contains information on how you can request access to

If you consider that another employer or employers

personal information held about you and how to seek

materially contributed to the injury or illness, you must

correction of that information.

provide the employer against whom this claim is being

You may make a complaint if you consider that the Seacare

made with a notice stating the name and address of the

Authority has interfered with your privacy or otherwise

other employer or employers.

breached its obligations under the Privacy Act 1988. Our

Privacy information

make a complaint and how we will respond.

The Seacare Authority is not likely to disclose personal

Personal information on this form is collected under

information to a person who is not in Australia or an

sections 63, 105 and 106 of the Seafarers Rehabilitation

external Territory, unless the information relates to

and Compensation Act 1992 to help the employer

an incident, investigation, injury or illness sustained

determine your eligibility for workers’ compensation and

while overseas, or treatment provided by an overseas

to allow the Seacare Authority to perform its functions

practitioner. If disclosure of personal information is made

under the Seafarers Act. If you do not provide the personal

to an overseas recipient, the Seacare Authority will comply

information requested in this form, it may not be possible to

with APP 8.

assess or manage your claim for compensation.

The Seacare Authority’s Privacy Policy is available

This form is used to collect information on behalf of the

at and is administered

Seacare Authority, your employer and the insurance

on the Seacare Authority’s behalf by Comcare. For

company. Your employer and the insurance company are

further information about our information handling

subject to their own obligations under Privacy legislation.

practices, for a copy of our Privacy Policy, to request an

Please contact your employer or the insurance company

amendment of your personal information or to make a

if you require further information on how they will manager

privacy complaint, please telephone 1300 366 979 or

your personal information under their privacy policies.

email privacy@comcare.gov.au.

Your privacy is important to us. The Seacare Authority

will only collect, use, store or disclose your personal

SEA01.1 May 2012

Australian Government Claim For Workers' Compensation

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