Every year, WorkCover Queensland receives around 95,000 workers compensation claims – and rejects about 4 per cent of them. It doesn’t sound like much, but it adds up to 3,800 declined claims each year.
Many of these are compensation claims for work-related psychological injury, as these tend to be denied more often than physical injury claims.
Find out what can you do if your claim is denied by your employer or by WorkCover, and how can you request a review of the decision. Speaking with a WorkCover lawyer can help you understand your rights and improve your chances of a successful review application.
Understanding workers compensation
Queensland’s workers compensation scheme comes under the Workers’ Compensation and Rehabilitation Act 2003. It’s a no-fault scheme, which means you can claim compensation for an injury or illness you suffer due to your work, no matter who caused it.
You can lodge a claim with WorkCover Queensland (or State Insurance Regulatory Authority in NSW), which assesses the claim and gives you relevant benefits and assistance.
There are two main types of claims:
- statutory claim – no-fault compensation that provides weekly wage payments, medical expenses and lump-sum payments for permanent impairment
- common law claim – a claim for damages due to a ‘serious’ injury, which can result in a larger payout but requires proof that your employer was negligent.
Your employer’s obligations
Your employer has a duty of care to provide you with a safe working environment every day. This includes holding workers compensation insurance through WorkCover or managing workers compensation as a self-insurer. They can be penalised for not having this.
If you need to make a workers compensation claim, your employer should cooperate with the claims process and assist you with your recovery and return to work.
Tell your employer about the injury or illness as soon as possible. They must then report it to WorkCover, including details about the incident and the nature of your work.
But you don’t need to ask your employer to lodge the claim for you – you can lodge it with WorkCover yourself. If you’re unsure about the process, a WorkCover lawyer can guide you through it. Your employer might need to provide information to support your claim.
WorkCover assesses the claim and decides whether to approve it. To make this decision, they might request medical reports, witness statements and more details. Your employer must cooperate with WorkCover and provide all requested information.
They must also assist in your return to work by providing suitable duties based on your doctor’s advice, modifying your work area and organising vocational rehabilitation for you if needed.
Importantly, your employer must not discriminate against you for making a workers compensation claim. There are heavy penalties if they do this.
Can your employer deny your workers compensation claim?
An employer generally doesn’t have the right to deny the lodgement of a workers compensation claim. In fact, they have a duty to forward an employee’s claim to WorkCover if they receive one.
However, some large employers have approval to be self-insured. They’re allowed to manage their own workers compensation payouts instead of paying premiums to WorkCover. Some manage claims in-house, while others use an external provider. In this case, your employer might be the one denying your claim. But they must comply with strict guidelines.
Unfortunately, some employers try to discourage workers from submitting a claim or reporting an injury. They might offer to pay you for your medical expenses directly or pay your wages while you recover.
This might sound like a good idea, but you will lose important entitlements and protection that WorkCover scheme gives you. Your employer might stop or refuse your payments at any time for no reason, leaving you stuck without income.
Workers compensation is your right as an injured worker and will protect you while you recover from your injury. The scheme will also help you to return to work safely when you’re ready and work with your employer to ensure a smooth transition.
If your employer is denying your claim or trying to prevent you making a claim, contact Main Lawyers. We can give you all your options.
Can WorkCover deny your claim?
Workcover can deny your workers compensation claim for several reasons. For example:
- You’re not considered a ‘worker’ under legislation.
- Your injury is not work related.
- You didn’t report the incident to your employer.
- You lodged your claim outside of the required timeframe.
- You lodged your claim in the wrong jurisdiction.
- Your psychological injury was caused by your employer’s ‘reasonable management action’.
Ensuring the best possible outcome
There are some things you can do to reduce the chance of your claim being denied and get the best possible outcome:
- Get medical treatment as soon as possible. Get an assessment of your existing and potential injuries. Provide as many details as possible. They will give you a certificate of capacity outlining your diagnosis, treatment, ability to work and more.
- Report the injury to your employer as soon as possible. The sooner you report the injury, the more likely your claim will be successful.
- Gather as much evidence as possible, including receipts, emails, photos, witness statements, previous complaints about work conditions, etc. Written records will provide evidence of your injury.
- Lodge your claim, supporting documents and all other requested information within the required time frame.
- Get advice from a legal professional to understand all your options and what you’re eligible for.
Getting a review of the decision
If WorkCover or a self-insured employer denies your claim or stops your payments, this isn’t the end of the road. You have the right to ask the Workers’ Compensation Regulatory Services to review the decision.
In Queensland, you have 3 months to request this review. In New South Wales, you have only 60 days.
Of the 3,800 claims that WorkCover Queensland rejects each year, around 1,170 are overturned or amended in favour of the injured worker after being reviewed. So you should never assume that you can’t get any compensation. Get legal advice first.
How Main Lawyers can help
Workers compensation is every Australian employee’s right. Unfortunately, some employers try to deny your right to workers compensation for a work-related injury – usually to protect their insurance premiums or because they don’t have the required insurance.
At Main Lawyers, our experienced workers compensation lawyers have helped many injured workers get the compensation they’re entitled to. So don’t delay – contact us for a no-obligation consultation today!