WorkCover claim rejected: What to do next

Question: My WorkCover claim has just been rejected- what are my next steps?

WorkCover

There are a number of reasons why an insurance company may reject your claim. This may include:

• the injured person does not meet the legal definition of a “worker”;
• the illness or injury of which complaint is made was not substantially work-related;
• the compensation sought is excessive given the nature and extent of the illness or injury;
• the worker had a pre-existing injury or condition which is the cause of ongoing symptoms.

In the event that an insurer disputes liability for a workers compensation claim they will advise of their reasons for same pursuant to a Section 78 Notice.

The Section 78 Notice must provide:

• an explanation as to why liability for the claim has been disputed;
• identification of the documents available to the insurer at which time the decision was made;
• a clear pathway or guidelines outlining how to go about requesting a review of the decision.

In the event that an injured worker receives a Section 78 Notice their options are:

1. Seek legal advice.

At Brydens Lawyers our workers compensation team are experts in the prosecution workers compensation claims on behalf of injured workers. Instructions are taken as to the circumstances of the injury, the file is recovered from workers compensation insurer and all relevant medical evidence is recovered. We will then assist every step of the way to ensure that the worker’s full entitlements are recovered.

A successful workers compensation claim can result in the worker receiving benefits for lost income, medical expenses, travel expenses, domestic assistance and in some cases, lump-sum compensation for permanent impairment.

2. Request a review by the insurer

An application form will be attached to the Section 78 Notice. Submissions can be made in support of the application for review. Additional information can also be lodged with the insurer. The insurer then has 14 days in which to respond. The insurer can either maintain the original decision or reverse that decision and accept the claim. If the rejection of the claim is maintained, then an application can be made to the Workers Compensation Commission.

3. Apply to the Workers Compensation Commission.

The Workers Compensation Commission is an independent Government Tribunal that resolves disputes between workers, employers and insurers. The Commission may appoint an arbitrator who is an independent decisionmaker to help the parties resolve the dispute.

If you have been injured at work and your claim has been disputed by the insurer, then you need to contact Brydens Lawyers today. Our expert team of lawyers in our Workers Compensation Division will provide expert legal advice and representation to ensure that you recover all of your entitlements.

If your claim has been accepted by the insurer and you have received benefits for loss of income, medical expenses and the like, you may also be entitled to claim for lump sum compensation for permanent impairment resulting from the injury.

If you are uncertain as to whether you have rights available to you under the workers compensation scheme, contact Brydens Lawyers without delay for a free, one-on-one free consultation and assessment.  Brydens Lawyers – WE DO workers compensation claims.