What causes Workers’ Compensation Claims to be denied?
The majority of employees who are injured at work file a WorkCover claim. A workers compensation claim might be filed for a mental injury, a physical injury, or both. WorkCover is in charge of deciding your claim at first instance. If your claim is denied, you have the right to appeal the decision.
Your WorkCover claim in NSW may be rejected if you failed to produce evidence of your injuries, or if your employer or insurer opposed to the claim and presented a more persuasive justification. It’s also possible that you didn’t take the appropriate measures to file your claim in the correct jurisdiction.
Your employer may try to have your workers compensation claim denied by claiming that you are ineligible to file a claim or that no one else witnessed you being harmed. These are not automatic reasons for your claim being denied. Your lawyer can assist you in achieving your objectives and obtaining the compensation you are entitled to as a result of your injuries.
The best thing you can do now is book a free consultation with one of our compensation lawyers at Law By Dan. We will investigate your claim and the reasons for rejection at no cost to you.
Under section 3(1) of the Act, the term “injury” is defined. It includes any of the following:
- a recurrence, aggravation, acceleration, exacerbation, or deterioration of any pre-existing injury or disease; industrial deafness;
- disease contracted by a worker; a recurrence, aggravation, acceleration, exacerbation, or deterioration of any pre-existing injury or disease;
- a recurrence, aggravation, acceleration, exacerbation, or deterioration of any Work-related stress or any other psychiatrically recognised disorder are examples of mental harm.
Exposure to industrial noise might result in industrial deafness. Industrial deafness claims are evaluated slightly differently than other harm claims.
You must establish that your work was a significant contributing factor to the disease in order to be reimbursed for an aggravation of a pre-existing injury or sickness. For example, if a person has a heart attack as a result of work-related stress, they must establish that their job played a significant role in the event. It does not have to be the sole reason somebody had a heart attack, but it must be a significant or dominant factor.
If your claim is denied for this reason, you will require supporting medical papers from your treating professionals, such as your GP or psychologist, that corroborate the diagnosis and causation of your injury.
If your WorkCover compensation claim is denied, what should you do?
If your WorkCover claim is denied, both Victoria and NSW provide you 60 days to appeal.
If you develop new symptoms as a result of your previous accident, you can reopen your Workcover claim in Victoria. If your injury has deteriorated, you may be entitled to further compensation for medical care.
What causes Workers’ Compensation claims to be denied?
Your WorkCover claim could have been denied for one of the following reasons:
- Your injury or illness has nothing to do with your job.
- Your employer disputes your description of how the injury or illness occurred.
- A pre-existing condition caused your injury or illness.
- Your injury was reported after the time limit had expired.
Is it possible for an employer to contest a Workers’ Compensation claim?
It is not your employer’s responsibility to approve or deny your WorkCover claim. Your state’s WorkCover body makes the final judgement.
WorkCover will contact your employer as part of their investigation into your claim. If your boss disputes your version of events, it could affect whether or not your claim is allowed.
If your employer is dissatisfied with WorkCover’s decision, they can request that it be reconsidered.
How do I appeal a Workers’ Compensation claim that has been denied?
If your WorkCover claim is denied, you have the right to appeal the decision.
The procedure for contesting a WorkCover claim is complicated and varies by jurisdiction. One of our workers’ compensation experts can walk you through your options and help you have your claim reviewed.
While the specific method varies by state, in general, the dispute resolution process will include multiple opportunities for both parties to meet and try to reach an agreement. If both parties are unable to reach an agreement, the case will be taken to court.
Reasons why Workers’ Compensation claims are denied
If the employer or insurance company believes there are significant disparities between your story of how your injuries occurred and what the employer believes to be true, your WorkCover claims may be denied. The following are the most prevalent differences that lead to a claim being rejected:
Injuries that occur outside of the workplace
Because the accident or illness occurred off-site and outside of your regular work tasks, it is not deemed a valid WorkCover compensation claim.
The specifics are in doubt.
The workers compensation claim may be denied if the employer disputes the specifics of the incident. This could include discrepancies in the cause of the injury, the location where it occurred, or the time it occurred.
Injuries that are unrelated
If your illness, injury, or even the incident itself is unrelated to your work responsibilities, your WorkCover claim may be denied. If you were hurt while conducting weekend recreational activities like playing sports or working on your property, and then tried to file a workers compensation claim for the same injury, your claim would be refused.
You failed to submit your report on time.
Any WorkCover claim must be filed promptly, usually within six months of the date of the injury, illness, or condition.
Injuries and illnesses that have occurred previously
Any injuries or illnesses you may have had prior to starting your current job are not covered by workers compensation.
What is the time limit for filing a WorkCover claim?
When it comes to WorkCover claims in Australia, there are severe time constraints. We recommend informing your employer of your injuries as soon as possible and starting the claim procedure.
If you wait too long to file your claim, you may lose your right to compensation. Our workers compensation experts can clarify the crucial time constraints relevant to your situation during your initial appointment with us.
What options do I have?
If you get a section 78 notice stating that the insurer intends to contest liability, you have the following options:
- Request that the insurer reconsider its decision.
- Request that the Workers Compensation Commission reconsider its ruling.
However, if you want to succeed in reversing the insurer’s responsibility judgement, you must meticulously evaluate all of the data obtained by the insurer that led to its conclusion and make a compelling case for why you believe they are liable.
Responding to a section 78 notice without assistance or counsel can be intimidating and stressful, especially if you’ve suffered a significant injury. That is why it is critical to get legal help.
