Request your own workers compensation claims history

This form is to request your own workers compensation information.

All fields are required unless otherwise indicated

Applicant details

Full name

Date of birth (dd-mm-yyyy)

Residential address

Suburb/Town

Post code

Postal address (if different to above)

Phone number (if email not available)

Your claim (tell us as much information as you can)

Date injury happened

Place where injury happened

Nature of injury (e.g. fractured leg)

Your employer at time of the injury

Your employer’s insurer (if known)

Proof of identity

Select proof of identity

Upload a copy of your valid identification in PNG, JPEG or PDF format, no larger than 5 MB in size

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