Register a Workers Compensation Case
Use this form to register a workers compensation case with HCCC Legal Services. We will contact you within 48 hours to discuss your matter further. Your information will be encrypted.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What state were you working in when you were injured?
Please Select
New South Wales
Victoria
Australian Capital Territory
Northern Territory
Was your injury at work the result of a single accident, or caused by conditions of work over a longer period of time?
One accident
Conditions of Work
Both one accident, and over time
Please give a short description of how you were injured
Please list the injuries you have suffered because of the work accident
If your injury was caused by a single accident or event, what was the date of this accident?
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
If your injury was caused by the conditions of your work, what was the first date you had to have a day off because of this injury?
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Select from the following options regarding your workers compensation case (select all that apply)
I have made a claim and the claim has been accepted by the insurer / Workcover.
I have made a claim and the insurer / Workcover has denied my claim for weekly payments
I have made a claim and the insurer / Workcover has denied my claim for medical expenses
I am interested in making a compensation for a serious or permanent injury
I have not made a claim yet and seeking initial advice
I have been told my work capacity is going to be assessed, or has been assessed
Have you have been to a court or a tribunal about your workers compensation claim already?
Yes
No
My case is schedule for a hearing in the future
Have you previously been given legal advice about your claim?
No I have not had advice from another lawyer
Yes I have a current lawyer but I am thinking of changing
Yes, I have a previous lawyer regarding this case but they are no longer representing me.
Please attach any files you would like HCCC Legal to review in relation to your case. We will securely store these files and destroy them if we are unable to assist you in your case.
Browse Files
Drag and drop files here
Choose a file
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How you would you like HCCC Legal Services to contact you for further discussion about your case?
By telephone during business hours
By telephone after hours
By video conference during business hours
By video conference after hours
By email
I will log on to the HCCC Legal Services contact page and arrange an appointment that suits me.
Submit
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