If your workers compensation claim is denied, there are options open to you to dispute the decision. The insurer that has denied your claim must notify you in writing of their reasons for the denial and provide information on the next steps available to you.
Here are some examples of common disputes:
- The insurer doesn’t consider the person making the claim to be a ‘worker’ (under the legislation).
- The insurer considers that employment wasn’t the main contributing factor to the injury.
- It wasn’t ‘reasonably necessary’ to have the medical treatment or to incur other expenses claimed.
- The insurer has blamed your mental health condition on your transfer, demotion, promotion, performance appraisal, discipline, retrenchment or dismissal or provision of employment benefits.
- The insurer is of the view that your employer’s actions were reasonable.
On 1 March 2021, the Personal Injury Commission (PIC) became the central body for resolving all workers compensation disputes.
If you have a dispute with an insurer, here are some options:
- Request an internal review by the insurer, who must respond within 14 days.
- Lodge a dispute directly with the PIC.
- Contact us on 13 15 15 and ask for free legal advice – it may be possible to get legal representation at no cost to you.