WorkCover acts as an important safeguard for individuals who are injured in the course of their employment by providing income protection and compensation for those who are unable to continue earning their regular income. However, if your claim is rejected this can cause significant stress on individuals. It is important to note that despite a claim being rejected, that does not mean this is the end of your claim as there may be other options available to you with getting the claim accepted.
Your WorkCover claim may be rejected if the insurer or employer believes there are discrepancies between your version of the events and your employers version. The common reasons WorkCover may reject your claim can include: –
1. Non-work injuries:
The alleged injury did not occur at work or was outside your regular work duties, so it is not covered.
2. Details in questions:
If your employer disputes the circumstances / details of the accident, then your claim may be rejected.
3. Unrelated injuries:
If your injury or illness itself is unrelated to your work duties, this includes, if you injured yourself doing recreational activities on the weekend such as playing sport.
4. Did not report the injury in time:
Normally if you do not report an injury from the work incident within six months of the injury, illness or condition, your claim may be rejected.
5. Pre-existing injuries and illness:
If you have any pre-existing injuries or illnesses that you may have suffered before you began working in your current role, you are unable to claim these.
Once you submit your WorkCover claim, they will carry out investigations as to the circumstances or the incident and the injuries you sustained. WorkCover will then decide to either reject or accept your claim on the basis of their investigations.
If your claim has been rejected by WorkCover, there are potential grounds and options available to you. It is important to obtain legal representation when deciding to review the decision as there are strict time frames and complex criteria’s that apply when disputing a rejected WorkCover claim.
Firstly, you need to obtain the reasons as to why your WorkCover claim was rejected. However, WorkCover normally will send you a copy of their reasons within twenty (20) days of the date of their decision. Once you have a copy of WorkCover’s reasons for rejecting your claim and you believe it is unfair or incorrect, you are able to request a review with the Workers’ Compensation Regulator.
The Workers’ Compensation Regulator (‘the Regulator’) are apart of the Office of Industrial Relations and are responsible for reviewing insurer decisions. The Regulator is as independent authority and are not affiliated with WorkCover which means they are not influenced by WorkCover or your employer.
To lodge a review you must ensure that you submit the relevant review application form pursuant to the Workers’ Compensation and Rehabilitation Act (2003) (‘the Act’) within three (3) months of the rejection decision. In this review, there are a few grounds that the Regulator will take into consideration, so it is important to outline why you think the decision is incorrect and provide further supporting evidence / documents such as medical reports and expert / witness statements.
Once you have lodged your review, the Regulator has twenty-five (25) business days to make a decision.
If you submit your review to the Regulator and they decide to uphold the original decision of WorkCover to not accept your claim, there still may be an opportunity to change the outcome.
If you disagree with the Regulator’s decision, you may have the right to appeal the decision to the Queensland Industrial Relations Commission (‘QIRC’). It is important to note that you must lodge the appeal with QIRC within twenty (20) business days of the Regulator’s decision date and serve a copy of the notice on the Regulator within ten (10) days.
Appealing the Regulator’s decision and having it overturned by QIRC normally only applies to certain situations and is a complex process. It is important to seek independent legal advice when deciding whether you think you should appeal the decision of the Regulator.
If you have encountered an injury or illness at work and had your WorkCover claim rejected, Littles Lawyers can assist you in navigating complex disputes and strict timeframes.
If you would like to have a free no-obligation chat in relation to a rejected WorkCover claim, please reach out to Ellie White today.
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