Published: 14 July 2016
Author: Peter Claven
What you need to know about WorkCover and work injury
What happens after lodging a WorkCover claim?
There is legislation that requires that your WorkCover claim must be dealt with promptly.
So if you’ve lodged one, keep an eye on it and don’t let it drift.
First, your employer must forward the claim to its insurer within 10 days. Their insurer in turn has just 28 days to make a decision on your claim.
Importantly, if you’ve had no word from your employer or their insurer by that time, your claim will be deemed to be accepted. So, record the date on which you lodge your claim and the deadline for a response.
In the meantime, you may be requested by the insurer to attend an appointment appointment with a doctor of their choosing. If you refuse to attend, your claim may be rejected.
The insurer may also commission a circumstance investigation report. This involves an investigator speaking to you and other relevant people about how the injury happened. The investigator will then compile a report regarding the circumstances of injury.
You should receive a letter (referred to as a notice) advising you whether your claim has been accepted or rejected.
What if my claim is rejected?
If your claim is rejected, the reasons for the decision will be noted.
If you disagree you may appeal the decision to conciliation. Conciliation is an informal process where the decision to reject your claim will be discussed between the parties. There will be a conciliator present who is from the Accident Compensation Conciliation Service.
Your matter may resolve at conciliation by way of the insurer withdrawing their notice and accepting your claim. The insurer make an offer to pay you a limited period of weekly payments and/or medical and like expenses.
If your claim is rejected and proceeds to conciliation, you should contact an experienced WorkCover lawyer near you for advice. Legal help at this point could be crucial to overturning a negative decision.
I know from experience that many people think that once their claim has been rejected, there is little chance of overturning WorkCover’s decision. This is incorrect. In fact, it’s quite common for rejected claims that were initially rejected to later be accepted.
Key points to remember:
- The law requires that you receive a response on your WorkCover claim within a total of 28 days from the day it is submitted to WorkCover.
- It is possible to contest the rejection of your claim. However, the right legal assistance increases the likelihood of success.