Workers’ compensation claims provide a safety net for employees injured on the job. When a claim is approved, workers are entitled to benefits that cover medical expenses and compensate for lost wages.
However, some claims are denied, leaving workers uncertain about their next steps. Before discussing what to do after a claim denial, it’s important to understand the common reasons for rejection.
Common Reasons Why Workers’ Compensation Claims Are Denied
Understanding why your workers’ compensation claim was denied is crucial, as many rejections arise from simple, fixable issues. However, more complex cases may require legal intervention. If your claim has been denied, seeking professional legal advice is often the best course of action.
Some common reasons for denial include:
- Incomplete or Late Paperwork: Claims may be rejected if forms are incorrectly filled out or submitted late by you or your employer. Ensuring all documents are accurate and submitted on time is essential to avoid delays or rejections.
- Injuries Outside Working Hours: Injuries occurring during non-working hours or lunch breaks are typically not eligible for workers’ compensation.
- Unauthorised Medical Treatment: Workers’ compensation schemes often require employees to seek treatment from approved healthcare providers. Claims can be denied if you visit an unapproved doctor, though emergency care is generally covered.
- Injuries Due to Horseplay: If the injury occurred during horseplay or other non-work-related activities, it might not be considered compensable under workers’ compensation.
- Employer Disputes: If your employer contests the circumstances of your injury, the insurer may deny your claim. Maintaining consistency in your account of the incident is vital.
- Pre-Existing Conditions: Claims may be denied if the insurer believes your injury is linked to a pre-existing condition rather than being work-related.
Understanding these reasons can help you address potential issues early and improve the likelihood of a successful appeal.
Steps to Take After a Workers’ Compensation Claim Denial
If your claim is denied, you can challenge the decision by following these steps:
- File a Case
Start by lodging a formal case to contest the decision. - Receive Notification
After filing, you will receive notification of your case number and other relevant details. - Request a Hearing
Submit a declaration of readiness to proceed, which will schedule a mandatory conciliation conference with a workers’ compensation tribunal or judge. - Attend the Hearing
You, your solicitor, the claims administrator, and their solicitor must attend the conference. If no agreement is reached, the matter will proceed to a formal hearing or trial. - Trial Process
Gather and present all required documentation during the trial. The judge will typically issue a written decision within 30 to 90 days. - Request Reconsideration
If you or the claims administrator disagree with the judge’s decision, you can file a petition for reconsideration to contest the outcome further.
Read more: How long do Workers’ Compensation Settlements Take?
United Legal Canberra is here to assist you with your workers’ compensation claim. For more information, call us at (02) 6295 2283 or email us at admin@unitedlegal.com.au. Scheduling an appointment takes just a few minutes.
