Yes, employers can dispute a WorkCover claim if they believe it’s invalid. However, they do not make the final decision. The employer’s insurer decides whether to accept or deny a claim. Employers can dispute the claim at any stage of this process, and over any number of issues. They can also dispute an accepted workers compensation claim by issuing notices to reduce or stop income payments or refuse to pay medical expenses. WorkCover WA has a structured process that aims to resolve disputes fairly and efficiently. Understanding how this system works can significantly affect the outcome.
Common Reasons an Employer May Dispute a Claim
Disputes can happen over several issues, which might include:
- Disagreement Over Compensation Amount: Employers might disagree with the amount of weekly income compensation or medical and health-related expenses.
- Injury Not Considered Work-Related: They believe that the injury didn’t happen due to the worker’s job duties or in a work environment. This is particularly common when there’s a lack of evidence connecting the injury with work activities.
- Pre-existing Conditions or Aggravation: Workers compensation may cover any previous injury/disease that work duties have further aggravated. However, if a worker has a prior injury/disease, employers may question whether the injury or disease was caused by work or if the symptoms coincided with employment. Aggravation claims require strong medical evidence to establish causation.
- Capacity to Work Disagreements: Employers can dispute workers compensation claims even after acceptance. They may dispute an accepted claim if they believe the injured worker has the capacity to return to work duties. Receiving a return-to-work notice may reduce or stop medical & income payments.
- Insufficient Medical Evidence: The employer may argue that the medical evidence doesn’t prove the severity or existence of the injury.
- Disputes About Worker Status: Independent contractors and labour hire arrangements can create disputes about whether the injured person qualifies as a worker under WA legislation.
- Inconsistent Reporting or Late Submission: Delays in reporting or differences between the workplace accounts and medical notes can often lead to scrutiny.
How the Dispute Process Works
A dispute is typically handled internally through discussions between your employer and their insurance provider. Depending on the nature of the dispute, the insurer may contact the injured worker asking for further information or evidence. We strongly recommend that workers contact a workers compensation lawyer if this occurs. Having a qualified lawyer act for you can help clear up any misunderstandings and provide the correct information where needed.
However, an application can be made to WorkCover WA’s dispute resolution services if the employer is unable to resolve the issue internally. WorkCover WA provide conciliation and arbitration services for resolving disagreements over workers’ compensation or injury management issues. Conciliation is where an impartial conciliator guides the discussion between both parties to resolve the dispute. If a resolution isn’t reached, the dispute proceeds to arbitration. This involves both parties presenting arguments and evidence to a qualified arbitrator, who makes the final decision about the dispute.
These resolution processes are often complex, so it’s very strongly recommended that injured workers seek legal representation before commencing any conciliation applications.
Need Representation for an Employer Dispute?
Trying to resolve a dispute on your own is difficult for many injured workers. It’s best to seek legal advice immediately when there is a dispute with your compensation claim. A workers compensation lawyer will review your dispute notice and recommend the next steps to take. Get in touch with Anvil Legal today for a free claim assessment. We can only provide a general assessment of your claim over the phone if we are given enough relevant information, which will also help us explain what options might be available to you going forward.