Experiencing a workplace injury and having a workers’ compensation claim declined can be stressful. In Cairns, Townsville, and across regional Queensland, a denied WorkCover claim may cause financial strain and questions about the available steps moving forward.
Understanding the WorkCover process and the legal framework in Queensland can assist workers in deciding how to proceed after a denied WorkCover claim. Below, common reasons for claim refusal and options for review are explained as set out by law.
Common Reasons WorkCover or an Insurer Might Deny a Claim
WorkCover Claims may be refused for several statutory reasons, including:
- Insufficient medical documentation or incomplete incident records.
- Disputed injury causation, such as questions around whether the injury occurred in the course of employment.
- Missed legislative reporting deadlines.
- Determinations that the injury is a recurrence of a previous non-work-related condition.
- Additional requirements for psychological injury claims, which may lead to more frequent disputes.
Steps for Reviewing a Denied Workcover
If a WorkCover Queensland claim (or a self-insurer claim) is denied, statutory review processes are available.
1. Request a Review of a Denied WorkCoverClaim
Should you receive a written notice from WorkCover Queensland (or a self-insurer) denying your claim, you have the right to apply for an independent review. Conducted by the Workers’ Compensation Regulator, this review is an opportunity to overturn the original decision.
You usually have 3 months from the date you receive the denied WorkCove decision to lodge your review application. Missing this deadline can forfeit your right to challenge the outcome.
2. Collect Evidence or Information that Supports a Review
To strengthen a review, you can provide:
- Updated medical reports
- Statements from witnesses
- Employer-logged incident reports
- Workplace records, evidence such as CCTV (where applicable)
Legal representation or advice from a workers’ compensation lawyer may assist in presenting supporting information that aligns with statutory requirements.
3. Wait for the Review Process
The independent review process usually takes around 25 business days. After submitting your application (including any new evidence), the Regulator reviews your case and may request further information. You will receive a written outcome, which may overturn the denial, uphold it, or in some cases, refer the matter back to the insurer for further assessment.
What Are Your Options When a Denied Workcover Claim Is Upheld?
If the Workers’ Compensation Regulator upholds the denial, you may have the right to lodge an appeal with the Queensland Industrial Relations Commission (QIRC). This is a more formal process involving filing documents and potential hearings, where you may present your case with evidence and witnesses.
Appeals can be complicated and governed by strict timeframes, generally 20 business days after receiving the review decision. A compensation lawyer can assist with meeting these requirements and help you present your case.
If further appeals are unsuccessful and Workcover payments cease, but you’re unable to return to your previous job, several support options could apply. You might:
- Claim alternative Centrelink benefits (such as JobSeeker)
- Pursue further medical evidence to establish a case for extended support
- Explore common law claims for damages against your employer if negligence played a role
Regional workers often face unique barriers to returning to work – such as distance from medical services, specialised industries, or fewer job options. Our local workers’ compensation solicitors are attuned to these realities.
Legal Help for When Workcover is Denied: Call Preston Law
Workers who have a denied Workcover claim in Queensland can consult independent legal practitioners for confidential advice and information about statutory rights under the Workers’ Compensation and PIPA frameworks. Initial consultations may clarify processes and answer specific questions, with no obligation to engage services.
Wellbeing and statutory entitlements are protected under Queensland compensation laws, and the appropriate processes outlined here are designed to safeguard your future options.
For more information regarding workers’ compensation and related legal processes, contact our lawyers in Cairns.
Disclaimer: This blog is intended for informational purposes only and does not constitute legal advice. For guidance tailored to your specific circumstances, please consult a qualified legal representative.