What are my options if a workers' compensation claim is rejected?

Published 26 Sep 2017

Workers' compensation offers invaluable financial support for staff who are injured or become ill during the course of their employment.

When everything runs smoothly, claimants receive the money they need for various expenses to cover day-to-day costs and rehabilitation efforts, if necessary. For serious injuries or illnesses, insurers may even pay out a lump sum for permanent impairment.

Unfortunately, not everyone's compensation claim is approved, and eligible people are often spuriously rejected. Let's take a look at some of the reasons why your claim may be get turned down, as well as examine what steps you should take next.

Why are claims rejected?

The workers' compensation watchdog - the State Insurance Regulatory Authority (SIRA) - lists three common reasons why cover providers may turn down a claim. These are:

  • The individual is not considered a 'worker';
  • The injury or illness was not deemed sufficiently work related; or
  • The claimed expenses are not reasonable for the injury or illness suffered.

A rejected claim can have a significant impact on your financial health, leaving you unable to support yourself and your family at a difficult time.

So what can you do?

1. Ask for a review

Contacting the insurer to request a review of their decision is likely to be your first step. According to SIRA, insurers should send you an application form so that you can explain why you feel a review is necessary. You should use this opportunity to attach any additional information relevant to your claim.

The insurer is required to respond within 14 days, at which point it will either maintain its previous decision or approve your claim. If you are rejected again, you still have options.

2. Seek help from the WCC

The WCC (Workers Compensation Committee) is a government-run agency that deals with disputes between injured staff and their employers or insurers. An arbitrator - an independent legal professional - may also be appointed to help resolve the dispute.

However, the WCC will only consider evidence you supplied in your original applications to insurers, so it's important that you include as much information as possible when making a claim or asking for a review.

3. Contact a specialist workers' compensation lawyer

At any point during a claim, you can enlist the services of an experienced lawyer to assist your case.

The workers' compensation system can be complex, which is why it helps to have someone who is able to guide you through every step of the process.

If you've had a workers' compensation claim rejected, or would simply like advice on how to pursue benefits while injured or ill, please contact us today.