Can your Worker’s Compensation Claim be Denied?

In Queensland, WorkCover is the type of insurance that covers workers in case they are injured on the job. Expenses such as medical and rehabilitation bills may be paid by WorkCover as well as a periodic income supplement or even a lump sum settlement to eligible workers who suffer significant, life-altering injuries. Not all injured workers are automatically covered by WorkCover however, and every claim will be investigated and approved or denied by WorkCover before they decide to pay it out.

WorkCover claims can be denied, which can be shocking and distressing to injured workers. Read on to find out more about why a WorkCover claim may be rejected and if you have any recourse to fight the decision.

Why might my claim be denied?

There are a few key reasons why WorkCover may deny your claim, including:

  • The insurer made a determination that your injury was not incurred during the course of your employment;
  • The injury was found to be pre-existing;
  • You failed to report your injury within a reasonable timeframe;
  • Your claim was unsubstantiated or unrelated to work. This could pertain to a case where a worker makes a claim related to alleged workplace bullying, conduct that turned out to be reasonable and legal disciplinary action or management; and/or
  • An Independent Medical Examiner did not consider your injury to be a barrier to your capacity to work.

What should I do if my claim is denied?

If your WorkCover claim is denied, you do have the option to have your claim reviewed. In some cases, the claim may not have been properly prepared, meaning that vital information was omitted or misrepresented. For this reason, it is prudent to seek the advice of a personal injury lawyer who can assist with your claim.

How can a personal injury lawyer help if WorkCover has been denied?

The best time to engage a personal injury lawyer is as soon as you have been injured in the workplace. Personal injury lawyers handle WorkCover claims on a daily basis and can support you to build a strong case, ensuring all the relevant information is included and represented in the most compelling way.

Without the help of a personal injury lawyer, your claim may be late, incomplete, or not strong enough to convince the insurer of its legitimacy.

If you have already submitted a claim for WorkCover on your own and were unhappy with the outcome you may still seek the assistance of a personal injury lawyer to help you seek a review with the Workers’ Compensation Regulator. You will have three months from the date that the insurer has rejected your claim to request a review.

What happens during the review process?

Within 20 days of your claim being rejected, you may request a ‘reasons for decision’ document. This document typically highlights if crucial information was omitted from your claim when it was submitted initially and can help you improve your submission for review.

A Review Officer from the Workers’ Compensation Regulator will be appointed to assess the case. This process is not something that occurs via the court and no further information will be requested by the Regulator. If the worker’s claim was investigated prior to the denial, it will not be reinvestigated.

Workers are afforded a ‘Right of Appearance’, which is the opportunity to speak directly to the Review Officer about their claim. If the worker elects to take this opportunity they must be informed that the Review Officer cannot provide any advice to the worker, they will simply consider what the individual has to say, and the facts presented to them.

Once the review is complete a decision will be made to overturn, reject or vary the original outcome of the claim. In this instance, a ‘variation’ refers to a revised payment, so some payments may be made to the claimant.

If your WorkCover claim has been denied and you need advice on seeking a review or you have recently been injured at work and want to pursue a new claim for WorkCover, our experienced personal injury lawyers can assist. Please contact us today on (07) 4052 0700. 

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