What to do if your WorkCover claim is rejected

WorkCover is an important safeguard for workers injured in the course of their jobs, providing invaluable income protection for those unable to continue earning their regular income. However, not all WorkCover claims are approved and some employees have their WorkCover claim denied, leading to financial loss, emotional stress and a diminished quality of life.

Examples of why WorkCover claims get rejected

Your WorkCover claims can be rejected if the employer or insurance company believes there are important discrepancies between your version of how your injuries occurred and what the employer believes to be true. The discrepancies that most commonly result in a claim being rejected include:

1. Non-work injuries

The injury or ailment occurred not at work but off site, or was outside your regular work duties, so is therefore not considered a legitimate WorkCover compensation claim.

2. The details are in question

If the employer disputes the details of the incident, the workers compensation claim may be declined. This could include inconsistencies over the cause of the injury, the place it happened or when it occurred.

3. Unrelated injuries

If your illness, injury or ven the incident itself is unrelated to your work duties, this could be a reason for having your WorkCover claim rejected. If you injured yourself doing recreational activities on the weekend like playing sport or working on your house, then wanted to claim workers compensation for that same injury, your claim would be denied.

4. You didn’t report in time

Any WorkCover claim must be submitted in a timely manner, usually within six months of the injury, illness or condition.

5. Pre-existing injuries and illnesses

Any conditions you may already have suffered before you began working in your current role cannot be claimed as workers compensation.

If you find your WorkCover claim denied, can you dispute it?

Once an investigation has taken place, WorkCover will decide to either accept or reject your claim. If you receive a letter stating that your claim has been rejected, you may be able to dispute the claim.

Timelines are tight for challenging rejections however, and disputing a WorkCover rejection can be complex with the process and timelines varying from state to state. It’s therefore important to have legal representation as soon as possible to assist in your dispute.

How do I appeal a rejected WorkCover claim?

Appealing a rejected WorkCover claim is done through an informal process called Conciliation. An independent body, The Accident Compensation Conciliation Service (ACCS), moderates between insurers and workers to find a resolution.

By lodging a request for a conciliation form, the ACCS will provide you with a conciliator who works as an intermediary between yourself and the insurer to resolve the dispute.

This process requires you to collect a variety of documentation:

• Conciliation form – This needs to be lodged within 60 days of your receipt of the decision.
• A copy of the decision – The decision you are disputing needs to be attached to your conciliation form.
• A cover letter – This will be required if you have more than a 60-day delay between receiving the decision and disputing it. Your cover letter should explain why there was a delay.

What are the time limits with WorkCover claims?

WorkCover claims must be made within six months of the injury, illness or condition occurring. This may be extended up to three years due to reasonable circumstances including:

• A delay in realising you are injured and unwell (this can happen with conditions like mesothelioma, which can take years to develop)
• Mistakes which occurred during the process beyond your control
• Absence from the state where your injury occurred

If you have your WorkCover claim denied in New South Wales and Victoria, you have 60 days to dispute the decision. WorkCover claims can be reopened in Victoria if new symptoms develop that are a direct result of your original illness or injury. If your condition worsens, you may qualify for more compensation.

With the rules around WorkCover claims and time limits varying from state to state, it’s wise to seek legal representation to assist in the process.

Make a WorkCover claim today

If you have encountered an illness or injury at work, or had your WorkCover claim rejected, LHD lawyers can help you navigate complex disputes and time lines. LHD Lawyers help everyday Australians receive the benefits they’re entitled to for WorkCover claims. We are so sure of our abilities to win your case that we stand firmly by our No Win No Fee Policy: if we don’t win, you don’t pay. Call 1800 455 725 for a no-obligation consultation about your case.

Author: Jasmina Mackovic

Original Publish Date: May 19, 2022

Last Updated: March 26, 2024