Claiming mental injury through WorkCover? Read this first 

life insurance
Written By Jam Villasanta

If you’re living or working in Victoria, you might’ve heard that the rules for WorkCover mental health claims changed in March 2024. Whether you’re an employee wondering if you’re eligible, an employer trying to support your team, or an adviser helping clients through the process—it’s important to know how these updates work. 

While mental health support is still here—and claims for serious psychological injuries are still valid, the new guidelines are designed to make sure that claims are tied to more significant impacts, not just everyday work stress. 

So what still counts? And how do you know if you—or someone you support—can make a claim? 

We’re breaking it all down so you can walk away with real clarity on what the changes mean and how to take the next best step. 

So, what’s changed? 

From 31 March 2024, Victoria introduced new rules around WorkCover and mental injury claims. It’s part of the WorkCover Scheme Modernisation Act, and it’s reshaped what counts as a mental injury and what doesn’t under the WIRC Act (Workplace Injury Rehabilitation and Compensation Act 2013). 

First things first: what is a mental injury now? 

To qualify as a mental injury under Victorian WorkCover, it must: 

✔️ Be diagnosed using the latest DSM (Diagnostic and Statistical Manual of Mental Disorders) by a GP or psychiatrist (not a psychologist), and 

✔️ Cause significant behavioural, cognitive or psychological dysfunction—think long-term impact, not a one-week stress meltdown. 

📌 Important: A Certificate of Capacity must show both a DSM diagnosis and proof of significant dysfunction to count. 

📌 Quick tip for employers and advisers: Encourage your teams to get support early and keep documentation from GPs clear and aligned with DSM terminology if WorkCover is being considered. 

Did the injury mostly happen because of your work? 

The new rules say your mental injury needs to be predominantly caused by work. Not partially. Not maybe. It has to be the main reason.  

That means if your anxiety was mostly triggered by stuff outside work (like family drama or financial stress), your claim might not be eligible. 

“Work-related mental health claims cost 3x more and last 3x longer than other claims.”
— Productivity Commission, 2019

The stress and burnout exclusion  

Here’s the big shift: not all stress-related claims will be accepted. 

If your injury was caused mainly by typical or expected workplace stress—like deadlines, performance pressure, or general workplace drama—it won’t be considered compensable. 

“Burnout caused by regular workplace stress is not covered unless the job involves traumatic events.”
— WorkSafe Victoria, 2024

But wait—there are exceptions 

If your role regularly involves trauma (think: first responders, paramedics, child protection workers), you could still be covered even if the stress comes from expected duties. 

Why? Because the "usual" in those jobs includes traumatic experiences that can cause mental harm. 

And no, you don’t need to have PTSD to qualify—but you do need: 

  • A DSM diagnosis 

  • Proof it caused significant dysfunction 

  • That the trauma is typical of your role 

💡 Good to know: Any mental injury that causes serious dysfunction and is diagnosed correctly may be accepted. 

Bullying and harassment? Still compensable. 

Workplace bullying, discrimination, or harassment are not considered ‘normal work events.’ So if these were the main cause of your mental injury, and you meet the other criteria, your claim can still be eligible. 

Just keep in mind—you’ll need solid documentation and support from your treating GP or psychiatrist. 

Too long; didn't read? Here’s the checklist: 

✅ Your job must be the main cause of the mental injury 

✅ It must be diagnosed using the DSM by a GP or psychiatrist 

✅ It must cause significant dysfunction (not just a few bad days) 

✅ Trauma-related stress may still be covered if it’s part of your usual duties 

❌ General burnout or work stress without trauma = not covered 

What now? 

If you or someone you know is navigating a WorkCover claim for mental injury: 

  • Get a clear diagnosis from a GP or psychiatrist (not just a psychologist) 

  • Keep records of what happened at work 

  • Seek legal or financial advice if you’re unsure about your eligibility 

These rules might sound stricter, but they're meant to help clarify what gets covered—so people with genuine work-related mental injuries get the support they need. 

And if your claim isn’t eligible? There are other ways to get mental health support—from Medicare-covered programs to life insurance with built-in mental health cover. Have a chat with your financial adviser who can help you through it. 

Read more about Practice directive – Mental injury eligibility HERE. 

Jam Villasanta
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