Having a workers compensation claim denied can be devastating. However, as RMB Compensation Lawyer ANNE BARLOW explains, there are avenues to challenge the decision:
Employers in NSW are required to take out workers compensation insurance to cover their employees if they are injured at work, travelling for work, or become sick because of their work.
Workers compensation entitlements include payments to cover your wages while you’re unable to work and your medical and treatment expenses. Depending on the extent of your injuries, you may also be entitled to a lump sum payment for permanent impairment and damages.
Unfortunately, eligible employees often have their claim rejected by the workers compensation insurer, which prevents them from receiving valuable entitlements while they are recovering from injury or illness. Common reasons why an insurer might try to deny a claim include:
- Your injury or illness is not related to work
- Your injury or illness is due to a pre-existing condition
- Your claimed expenses are not reasonable for the injury or illness suffered
- You are not considered a ‘worker’ under the legislation
If the insurer disputes liability for your claim, they must advise you of their reasons in writing. This is called a Section 78 Notice and it must provide:
- The reasons why the insurer is denying your claim;
- The documents that the insurer relied upon when making its decision;
- Information about the next steps available to you if you do not agree with the decision.
If the insurer disputes liability for your workers compensation claim there is help available. You are entitled to challenge the decision and we strongly recommend that you contact our workers compensation experts for free advice on what the decision means and how it can be reviewed.
If you receive a Section 78 Notice, you can request an internal review of the decision or refer the matter to the Personal Injury Commission (PIC), which is an independent tribunal for injured employees claiming against the workers compensation insurer.
If you are legally represented, our experts will lodge the application with the PIC on your behalf. The application must include all the information you intend to rely upon in support of your case as you may not be allowed to provide more information later in the PIC process.
The dispute resolution process involves several opportunities for both parties to negotiate a resolution to the dispute. If a suitable outcome cannot be reached, the matter will be heard by a PIC member. This is known as an Arbitration Hearing and can be a daunting process if you are not legally represented.
At any point during a claim or a dispute, you can workers compensation experts for advice about your entitlements. Our lawyers are approved by the Independent Review Office (IRO) which means that our fees are covered by IRO so they are not deducted from your workers compensation benefits. IRO will also cover any report fees. You can also contact us by by phone or our 'Ask a Question' tool on our website. It costs nothing to ask us about your rights.