‍Understanding 'Arising Out of Employment' vs. 'In the Course of Employment'

Whether WorkCover accepts your claim usually depends on two tests: if the injury happened ‘in the course of employment’, meaning the time, place and work activities involved, and if it ‘arose out of employment’, meaning your work was a significant contributing factor.

Why This Matters for Your WorkCover Claim

• Injuries at work aren’t automatically covered. Even if it happens on work premises during work hours, coverage isn’t guaranteed.
  
• Your employment must significantly contribute to the injury for WorkCover to accept the claim.
  
• Many claims are rejected for lack of a clear connection to work, making it crucial to understand this before filing.
  
• Knowing this helps you gather the right evidence and strengthens your chance of a successful claim.

This guide breaks down the two key legal tests in plain English, gives real-world examples of tricky situations, and shows you how to protect your rights when work and personal factors overlap. Let’s get started.

Understanding the Two Legal Tests

What does ‘in the course of employment’ mean?

This test asks whether your injury happened during work time, at a work location, or while doing work activities. It's about the circumstances surrounding when and where you were injured.

This typically covers:

• Work premises during work hours: Injuries in the office, on the factory floor, or at any official work site while you're on duty
• Authorised breaks: Lunch breaks taken at or near the workplace, morning tea breaks, and other scheduled rest periods
• Work-related travel: Driving between work sites, visiting clients, or attending off-site meetings (but not your normal commute home)
• Work social events: Company functions where attendance is encouraged or expected by your employer

Real-world example:

Sarah slipped and twisted her ankle in the office kitchen during her morning tea break. Because the injury happened at the workplace and during an authorised break, it is considered ‘in the course of employment’ and should be covered by WorkCover.

What does ‘arising out of employment’ mean?

This test asks whether your work actually caused or contributed to your injury. It's about the connection between your job and what happened to you.

The critical requirement here is that your employment was a significant contributing factor to your injury. Importantly, your work doesn't need to be the main cause or only cause, just a significant one. This means:

• Work must contribute more than slightly or insignificantly to the injury
• Other factors can also contribute (like pre-existing conditions or personal circumstances)
• The injury must have some meaningful connection to your job duties or work environment

Real-world example:

A warehouse worker, Graham, with a minor pre-existing back condition, lifts a heavy box at work and herniates a disc. Even though the pre-existing condition contributed to the injury, if the lifting task was a significant contributing factor, the injury arose out of employment.

Your Rights and Your Obligations

What you're entitled to:

• Medical expenses coverage: All reasonable medical treatment, including doctors, specialists, physiotherapy, and prescribed medications related to your work injury
• Weekly income payments: Compensation for lost wages while you're unable to work, typically starting at 85% of your pre-injury earnings for the first 26 weeks
• Rehabilitation support: Return-to-work programs, occupational therapy, and workplace modifications to help you recover and get back to work safely
• Lump sum compensation: For permanent impairment if your injury results in lasting damage (this is separate from weekly payments)
• Common law rights: If your employer was negligent, you may be able to make a separate claim for additional compensation beyond WorkCover benefits

What you must do:

• Notify your employer immediately: Report your injury as soon as possible, ideally within 30 days, using your workplace's incident reporting system
• See a doctor and explain the work connection: Be specific about how work caused or contributed to your injury, as medical evidence is crucial to your claim
• Lodge your WorkCover claim within 6 months: Late claims are only accepted in exceptional circumstances where you have a valid reason for the delay
• Participate in return-to-work planning: Cooperate with reasonable rehabilitation programmes and suitable duties offered by your employer

Common Scenarios and Frequently Asked Questions (FAQ)

Does WorkCover cover injuries that happen during a lunch break?

The short answer: It depends on where you were and what you were doing. Injuries during authorised breaks are often covered if they happen at or near the workplace.

What to do:

• Document where the injury occurred and whether it’s a place workers commonly go during breaks.
  
• Check if your employer provides lunch facilities or if workers routinely leave the premises.
  
• Note whether the break was at a scheduled time and you were doing something ordinary, like getting food or using facilities.

Important note: If you went somewhere for personal reasons and it wasn’t part of your work or a break, WorkCover is unlikely to cover the injury.

Can I claim WorkCover for stress or psychological injury caused by a performance review?

The short answer: No. You probably cannot claim for stress or psychological injury if the performance review was conducted in a reasonable fashion. Queensland law excludes psychological injuries resulting from reasonable management action, such as standard meetings or requests.

What to do:

• Document exactly how the performance review was conducted, including harsh language, lack of process, or unfair treatment.
  
• Compare the review process to your employer’s policies and note whether they were properly followed.
  
• Gather evidence if the review was part of a pattern of bullying or harassment.
  
• Show if the review contained false accusations or was conducted unreasonably.

Important note: For the exclusion to apply, both the action itself and the way it was carried out must be reasonable. If either was unreasonable, you could still make a claim.

Am I covered by WorkCover if a pre-existing back condition gets worse at work?

The short answer: Yes, if your work significantly contributed to worsening your condition. Pre-existing injuries don't automatically disqualify you from WorkCover.

What to do:

• Obtain medical records showing your condition was stable or manageable before the work incident.
  
• Document the specific work activity that aggravated your condition (e.g., lifting, repetitive movement, accident).
  
• Get medical evidence explaining how the work activity exceeded what your condition could normally handle.
  
• Show the connection between the work incident and the worsening of your symptoms.

Important note: The definition of an injury includes aggravation, acceleration, or recurrence of pre-existing conditions, so don't assume you're not eligible.

Is an injury sustained while driving to a client meeting considered a work injury?

The short answer: Yes, travel between work locations or to meet clients is generally ‘in the course of employment’, unlike your regular commute to and from home.

What to do:

• Keep records of the work purpose for your travel, such as emails, meeting confirmations, or work orders.
  
• Document whether the travel was directed by your employer or was necessary for your job.
  
• Note whether you made any significant personal detours before the injury occurred.

Important note: Your normal commute to and from your regular workplace is NOT covered, but travel for work purposes during your workday generally is. The distinction matters significantly for workers in multiple locations.

Does WorkCover cover injuries that happen at a work Christmas party?

The short answer: Usually yes if attendance was encouraged or expected by management, even if it was technically voluntary.

What to do:

• Document how the event was communicated, including whether attendance was expected or encouraged.
  
• Note whether management or supervisors attended the event.
  
• Check if the event was during work hours or held at the workplace.
  
• Confirm whether the employer organised or paid for the event.

Important note: Optional after-work drinks at a pub are less likely to be covered than official work functions. Bear this in mind before lodging a claim.

Does WorkCover cover injuries that happen during remote or home-based work?

The short answer: Yes, if you were doing work activities in your designated home workspace during work hours, and your employment significantly contributed to the injury.

What to do:

• Document your approved work-from-home arrangement with your employer.
  
• Show you were performing work duties when the injury occurred.
  
• Demonstrate that the injury happened in your designated work area, not in personal spaces (kitchen, garage, etc.).
  
• Provide evidence linking the injury to work activities, such as ergonomic setup issues (height of your desk) or work equipment failures (electrical faults, etc.).

Important note: Injuries during personal activities at home (making lunch, doing laundry between meetings) are much harder to prove as work-related.

Read our article on this topic: Does Workers’ Compensation Cover Me Working from Home in Queensland?

Step-by-Step Process: Protecting Your WorkCover Claim

1. Report the injury to your employer immediately

Use the official incident report form rather than just verbal notification. Include specific details about how work contributed to your injury, even if other factors were also involved.

2. See a doctor within 48 hours and explain the work connection

Be specific about the work activities that caused or contributed to your injury. Don’t downplay the work connection, as the doctor’s notes are key evidence for your claim.

3. Keep detailed records of everything

Take photos of the scene, save emails and messages, document witnesses, and keep copies of all medical reports and certificates.

4. Lodge your WorkCover claim within 6 months

Your employer should provide claim forms, or you can get them directly from WorkCover Queensland. Include all supporting medical evidence with your application.

5. Cooperate with WorkCover’s investigation

Answer questions honestly and provide requested information promptly. Delays or incomplete information can lead to claim denials.

6. If your claim is denied, seek legal advice immediately

1. Many denied claims are later approved with proper evidence and representation. Don’t assume the initial decision is final until after you’ve consulted with professionals.

Documents You’ll Need for a WorkCover Claim

• Incident report form – Complete as soon as possible after the injury. Include what happened, where, when, and how work contributed.
• Medical certificates and treatment records – Doctors, specialists, physios, and other providers should clearly document the work-related connection and understand your duties.
• Employment records – Pay slips, contracts, position descriptions, and duty lists to prove employment and outline your job tasks at the time of the injury.
• Witness statements – Written accounts from colleagues who saw the incident or can confirm hazards, work demands, or management actions that contributed.
• Pre-injury health records – If you have a pre-existing condition, provide records showing it was stable or managed before the work incident to support that your working conditions significantly aggravated it.

Legal Framework

Primary legislation: The Workers' Compensation and Rehabilitation Act 2003 (Qld) governs all WorkCover claims in Queensland, setting out eligibility requirements, benefits, and exclusions.

What this means for you:

• You must meet both tests: the injury must have occurred ‘in the course of employment’ AND your employment must be a "significant contributing factor"
• Psychological injuries have special rules that exclude injuries resulting solely from reasonable management action.
• For workers who travel interstate or work in multiple locations, courts within Queensland apply a ‘state of connection’ test to determine which state's workers' compensation laws apply to your claim

When To Act Immediately:

Your employer discourages you from reporting the injury

• This is illegal and suggests they’re prioritising insurance premiums over your rights. Report to WorkCover directly if necessary.

You’re offered a cash payment to not make a claim

• This almost always leaves you worse off and may be insurance fraud. Correctly processed WorkCover claims provide ongoing benefits, not just one-time payments.

WorkCover denies your claim, citing ‘not a significant contributing factor’

• This is the most common reason for denial and is often incorrect. Many denied claims succeed with proper medical evidence and legal support.

You’re told you can’t claim because you have a pre-existing condition

• This is false. Pre-existing conditions don’t disqualify you if work significantly contributed to worsening your condition.

Your employer retaliates after you report a work injury

• Adverse action after making a WorkCover claim is illegal and can form the basis for additional claims beyond your injury compensation. 

Top 4 Mistakes to Avoid in Your WorkCover Claim

1. Delaying medical treatment or failing to explain the work connection
Gaps in treatment or unclear descriptions can weaken your claim. Make sure doctors record exactly how work contributed to the injury.

2. Accepting your employer’s claim that the injury isn’t work-related
Employers and insurers may minimise work factors. Seek independent legal advice instead of relying solely on their assessment.

3. Not documenting psychological symptoms as they develop
Psychological injuries are harder to prove later on. Keep detailed notes about stressors, management actions, and how symptoms progress.

4. Giving inconsistent accounts of how the injury happened
Any inconsistency can be used to deny your claim. Be accurate and consistent in all reports, medical visits, and forms. 

When to Seek Legal Advice

Get advice as early as possible, especially if:

• Your claim has been denied or disputed - WorkCover Queensland regularly denies legitimate claims, particularly for mixed-cause injuries, psychological injuries, or when employers dispute the work connection. Early legal advice dramatically improves your chances.

• Your injury involves both work and personal contributing factors - These borderline cases are where the ‘significant contributing factor’ test matters most. Legal expertise helps you gather the right evidence to prove the connection.

• You're facing the ‘reasonable management action’ exclusion for psychological injury - This exclusion is complex and insurers apply it too broadly. Lawyers experienced in psychological injury claims know how to challenge unreasonable management actions effectively.

• Your injury occurred during breaks, travel, or work social events - The boundaries of ‘in the course of employment’ aren't always clear. Legal advice helps you understand whether your specific circumstances qualify.

• You have a pre-existing condition that was aggravated by work - Proving that work was a significant contributing factor to worsening a pre-existing condition requires specific medical and legal strategies.

• Your employer is pressuring you not to claim or offering a settlement - Protect yourself from being short-changed. Early legal advice ensures you understand your full entitlements before making any decisions.

Why early advice matters:

• Understand your full rights and entitlements under both WorkCover and potential common law claims.
  
• Access rehabilitation and support services sooner with proper claim lodgement and professional advocacy.
  
• Protect your compensation claim from common pitfalls like inadequate medical evidence or missed deadlines.
  
• Get expert guidance early before time limits expire or evidence becomes harder to gather.

Key Takeaways

Two separate tests determine eligibility

Your injury must have happened ‘in the course of employment’ (when, where, and during what activities) and ‘arisen out of employment’ (work was a significant contributing factor).

‘Significant contributing factor’ doesn’t mean ‘main cause’

Your work only needs to contribute meaningfully to your injury, not be the sole or primary cause. Other factors can also play a role without disqualifying your claim.

Pre-existing conditions don’t disqualify you

If work significantly contributed to making your condition worse, speeding it up, or aggravating it, you are still eligible for WorkCover.

Psychological injuries face extra hurdles

The ‘reasonable management action’ exclusion can deny many psychological injury claims, but the action must be both substantively reasonable and carried out reasonably to disqualify you.

Document everything immediately

• The strength of your claim relies heavily on up-to-date and accurate evidence. Report injuries promptly, explain work connections clearly to doctors, and keep detailed records of everything related to your injury and its causes.

Get Help Now

If you've been injured and believe your work significantly contributed to the injury, getting early legal advice can help you understand your rights, access the rehabilitation you need, and protect your ability to claim compensation.

Many injured workers in Queensland lose thousands of dollars in compensation simply because they don't understand these two legal tests or because they accept an insurer's initial denial without being aware that they can challenge it.

Contact Smith's Lawyers today:

• Call 1800 960 482 for a free, no-obligation consultation with experienced work injury lawyers
• No upfront costs: We operate on a No Win, No Fee, No Catch® basis, meaning you pay nothing unless your claim is successful
• Request a callback: Use the form below to have our team contact you at a time that suits you

Our team has helped hundreds of workers navigate complex WorkCover claims involving mixed causes, pre-existing conditions, psychological injuries, and borderline scenarios. We know how to prove the work connection even when insurers can’t.