Workcover claim rejected victoria

Once your claim has been submitted your WorkSafe agent will assess your claim. Assessment of your claim Your WorkSafe agent is responsible for assessing your claim and determining liability. Disputing a rejected claim. If you believe your claim has been unfairly rejected , your first option is to dispute the finding. How you should do this and the formal steps included in the dispute resolution process vary from state to state.

For this reason we recommend contacting a legal professional at this point, if you haven’t already. Workcover will often reject a claim at first instance for an assortment of reasons (eg. Workcover does not consider the injury to be “work related” etc ). When Workcover rejects a claim , it will issue a “Reasons for Decision” stating the reasons why the claim has been rejected. Most of all, it was criticised for dragging claimants through the system, sometimes for years. Claims process for workers Decide the type of claim you’ll make and understand the claims process from start to finish.

It is important that you lodge a request for conciliation within days of a decision being made. During that time, depending on what the reason for the rejection is, it is important to obtain information in support of your claim. The claims manual is a guide for WorkSafe agents to help make decisions in line with legislation.

It includes information about claims management, weekly payments, medical and like services, return to work, specialised payments and dispute resolution. If you have difficulty giving this claim to your employer, or your employer refuses to take receipt of the claim form, you can send it directly to the agent or WorkSafe if the agent is not known See your medical practitioner to obtain a WorkSafe Certificate of Capacity (medical certificate) if you are unable to work and want to claim weekly payments, and give the original copy to your employer. If you are injured and need time off work you can make a claim for weekly payments to cover part of your lost income.

Your weekly payments will be based on your pre-injury average weekly earnings (PIAWE), entitlements to sick leave, annual leave and redundancy payments. You must get a Certificate of Capacity if you wish to claim for weekly. The VWA allocates work to its authorised insurers. Workcover claims within Victoria are handled by designated claims agents which cover most employers for work related injuries or an employer who has become a self insurer.

According to WorkSafe, it currently accounts for per cent of workers’ compensation claims in Victoria. If you operate your business in Victoria, you will be required to register with WorkSafe if your company’s annual remuneration is over $500. If it rejects the claim , it should provide you with written notice of the rejection. If the authorised insurer does not provide written notice of its decision within days, the claim is deemed to have been accepted. WorkCover is regulated on a state-by-state basis.

The Government and WorkSafe Victoria accepted her recommendations In a scathing report following an 18-month investigation, Victorian Ombudsman Deborah Glass found WorkSafe agents were continuing to make unreasonable decisions, in some cases for financial incentives, leaving injured workers without compensation. According to the report, “the State Ombudsman is investigating if the payment of financial bonuses by WorkSafe Victoria to its agents has contributed to an increase in the number of claims being rejected”. Other insurance companies who work for WorkSafe include Allianz, CGU and QBE. Your claim may be rejected by the insurance company for a number of different reasons.

If your claim has been rejecte you can still do the following to appeal the decision: Request the WorkSafe Agent to review their decision The review will be made by a senior person at the WorkSafe agency who wasn’t involved in the original decision. My workcover insurer has rejected my workcover claim. I am going to apply for arbitration. Am I permitted to return to work while waiting for arbitration? It matters because laws vary by location.

Been off sick while waiting for workcover. Worker’s compensation fraudis when a person dishonestly obtains a payment or other benefit under workers’ compensation legislation in that jurisdiction. Panel firm recommendation. The panel firm is responsible for recommending whether a death is work-related.

If you do not notify your employer in writing within days of becoming aware of the injury, then your claim may be rejected.