REPORT A WORKPLACE INJURY / WORKERS COMPENSATION CLAIM


As a Stockinsure SSAC Member, you gain access to our workers compensation specialist partner, Coverforce Workplace Services (CWS).

Please complete the following form to notify Coverforce Workplace Services (CWS) of your workplace injury / workers compensation claim. Our team use this information to lodge your worker’s claim with your respective insurer. By completing this form, it enables us to get your worker's claim moving quickly in supporting you & your injured worker with the return to work process.

To ensure the timely claim lodgement, we have deliberately not made every field mandatory given we understand this information may not be available at the time of completion. Once your claim is lodged, we will contact you if additional information or clarification is required by your insurer. Please complete as much as possible as this would streamline the process for you and your worker.

It is our pleasure to introduce Coverforce Workplace Services (CWS). Established in 2016, Coverforce Workplace Services (CWS) primarily operates through client & broker referrals. Our team provide innovative people, health & safety services tailored to each client’s unique circumstances in helping clients better manage risks, issues, costs & related matters in your business.

Got a question? Please contact our friendly team during business hours on (02) 9098-5500.

On behalf of Stockinsure, thank you for partnering with Coverforce Workplace Services (CWS).

Many thanks & best wishes,


Matthew Starr | Stockinsure CEO | Julie Ring | Coverforce Workplace Services (CWS) Director

 Worker Details
Permanent (Full-time)
Permanent (Part-time)
Casual
Fixed Term (Contract)
Contractor
Volunteer
Apprentice
Trainee
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Yes
No
N/A
 Employer Details & Contacts
Supervisor/Manager
Other
 Important Information
Yes
No
Yes
No
 Injury Details
 Injured Worker's Current Status
Yes
No
Yes
No

HEALTH ABILITY - SIRA Provder # 752

[email protected]

(02) 8317-7777

Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
 Certificate of Capacity (CoC)
Yes
No
Drop file here, or click to select
N/A
Pre Injury Duties (PID)
Trial Pre Injury Duties
Permanently Modified Duties (PMD)
Retired
Suitable Duties Full-Time (SD FT)
Suitable Duties Part-Time (SD PT)
Unfit
Unknown
Yes
No
 Wage Entitlements
Yes
No
N/A
Salary
Hourly wages
Other
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Weekly
Fortnightly
Monthly
Other
Ad Hoc
Yes
No
N/A
Drop file here, or click to select
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
 Declaration

I confirm this is accurate & based on the information available to me at the time of completion.

I will contact Stock and Station Agents Co-Operative Limited to provide updates if the above information changes or new information becomes available.

Upload a File

Declaration

By submitting this form I declare that the information provided is, to the best of my knowledge and belief, accurate and complete.