Background: Fear avoidance beliefs have been demonstrated significant predictors of disability and work status post occupational injury and appear particularly important in explaining the transition from acute to chronic disability. Objective: This study examined the relationship between fear avoidance beliefs, health-related quality of life, and their influence on return to work (RTW) outcomes, including durable RTW, post-occupational injury. Methods: A total of 1179 questionnaires were posted to clients previously receiving vocational rehabilitation services from the Return to Work Assist program in Queensland, Australia. Participants were asked to indicate their current RTW status in addition to completing questionnaires measuring fear avoidance beliefs and physical and mental aspects of health related quality of life. Results: The statistical analyses included 104 participants. ANOVA indicated the RTW group reported significantly better physical health than the no RTW (NRTW) group. No significant differences were observed between groups on mental health. ANOVA also indicated that participants with RTW outcomes reported significantly lower fear avoidance beliefs than the NRTW group. However, when controlling for physical health, no fear avoidance group differences were observed. Significant correlations were observed between fear avoidance beliefs and measures of physical and mental health. Conclusions: The findings are suggestive of a reciprocal relationship between fear avoidance beliefs, physical, and mental health in which fear avoidance beliefs hinder recovery from physical injury, contributing to deterioration in mental health. These findings also suggest that collaborative practice between medical practitioners, psychologists, and physiotherapists is likely to be required to improve RTW outcomes for this complex client group. Identifying and addressing fear avoidance beliefs early in the treatment process may decrease the likelihood of long-term disability and work absence.