What happens if my workers compensation claim is denied?

PUBLISHED 27 Jan 2020

All jurisdictions in Australia provide some form of workers’ compensation scheme. In Queensland, the scheme is operated entirely by the state, while in NSW, Victoria and South Australia, insurers serve as scheme agents on behalf of the government authority. In Western Australia, Tasmania, Northern Territory and ACT, insurers privately underwrite the scheme.

Workers’ compensation can provide invaluable financial support for those who are injured or become ill during the course of their employment. A successful claimant can receive the money they need for day-to-day costs and rehabilitation efforts, and insurers may even pay out a lump sum for permanent impairment. However, workers’ compensation claims are notorious for being rejected – in many cases almost out of hand.

Why was my claim rejected?

The most common reasons why a claim might be turned down include:

  • You are not considered a “worker”
  • Your injury or illness is not found to be sufficiently work-related
  • The expenses you have claimed are not deemed reasonable for the injury or illness suffered

If your claim is rejected, your financial well-being can suffer, even to the point that you become unable to support yourself and your family.

How can I appeal a claim?

You can try contacting the workers’ compensation insurer to request a review and attach any additional information you feel helps to prove your claim, and they will be required to respond within 14 days. In rare cases, they may reverse their decision. Otherwise, your claim will be rejected again.

At that point, you can appeal to the WCC (Workers Compensation Committee). You can’t add any more information at that time, which is why it’s important to include as much information as you can in your original claim and any request for review to the insurer. In some cases, the WCC will rule that the rejection of your claim was incorrect, and you can recover from there.

What if my review and appeal to WCC fail?

Be aware that at any point, you can seek the counsel of a specialist workers’ compensation lawyer to assist your case. This can be particularly important if you must take your case before the court. But keep in mind that pursuing your workers’ compensation case in the court will incur costs, and you may be liable for a portion of said expenses even if you win your claim. Having a lawyer on your side who is experienced in workers’ compensation may be able to help you maximise your claim.

If you are currently struggling with a workers’ compensation claim rejection, contact Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers.

Call us now on 1800 004 878 to book a free appointment with one of my compensation experts, or email your enquiry.