REPORT A WORKPLACE INJURY / WORKERS COMPENSATION CLAIM


Please complete the following form to notify ABILITY GROUP 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 ABILITY GROUP. Established in 2012, ABILITY GROUP primarily operates through client & partner referrals. Our team provide innovative yet affordable people, health & safety services tailored to each client’s unique circumstances in helping clients better manage risks, issues, costs & related matters in your business. After 8 years in development, we are also excited to advise that our purpose-built modular cloud-based Software as a Service (SaaS), ENABLE>SYSTEMS (E>S) by AMPLEXUS SOLUTIONS is supporting businesses of all sizes in better managing business & operational functions such as Customer Relationship Management (CRM), WHS, People & HR, Staff (Time, Attendance, Scheduling, messaging, etc), Asset management, files, document generation & much more.

Got a question or would like an E>S demo? Please contact our friendly team during business hours on (02) 9098-5500.
Many thanks & best wishes,

Julie & Marc

ABILITY GROUP Owners

MAKING THINGS HAPPEN!

 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
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No
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 Employer Details & Contacts
Supervisor/Manager
Other
 Important Information
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No
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No
 Injury Details
 Injured Worker's Current Status
Yes
No
Yes
No

HEALTH ABILITY - SIRA Provder # 752

[email protected]

(02) 8317-7777

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No
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No
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No
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No
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No
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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
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No
 Wage Entitlements
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No
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Salary
Hourly wages
Other
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No
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No
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Weekly
Fortnightly
Monthly
Other
Ad Hoc
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No
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No
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No
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No
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 Declaration

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

I will contact ABILITY GROUP Pty Ltd to provide updates if the above information changes or new information becomes available.

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Declaration

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