Workers’ Compensation plays a vital role for Perth workers who sustain injuries at their jobs. It offers income protection for those who are unable to earn their regular wages due to their injuries. Unfortunately, not all compensation claims are approved, leaving injured workers with financial losses and stress. Many workers’ compensation claims are wrongly delayed or rejected without workers realising. This blog outlines some of the main reasons your claim might have been delayed or rejected, how to prevent it, and what to do with a rejected claim.
Reasons Why Your Workers’ Compensation Claim Might be Rejected:
WorkCover Claim Form is Filled Out Incorrectly
Making sure your Workers’ Compensation Claim Form is filled out correctly is the most important part of claiming compensation for your work injury. It’s ideal to fill the form out with as much accurate information as possible.
Simple mistakes can lead to the workers’ compensation claim being delayed or declined. This includes incorrect dating of the injury and other inconsistencies in the details of the incident. It’s essential to fill out the details of your work injury accurately the first time you lodge your claim. This will prevent any further delays in your compensation process.
The workers’ compensation form can look daunting because there’s so much information to fill out. For more information, read our blog on making a WorkCover claim in WA or contact Anvil Legal for assistance.
Not Signing the Consent Authority on the Claim Form
The consent authority on your WorkCover claim form gives your employer’s insurer permission to collect your personal information to assess your claim for workers’ compensation. When filling out your claim form, reading and signing the consent authority is optional. However, failing to sign the consent authority may delay a decision by the insurer on your claim. So, even though it’s optional, it’s ideal to sign it to prevent any delays.
Your Injury is Not Work-Related
One of the primary reasons for the rejection of a workers’ compensation claim is when the injury is not deemed work-related. Workers’ compensation is designed to provide benefits to employees who sustain injuries or illnesses caused by their job duties or work environment. It also covers those who have a previous injury/disease aggravated by work duties and the employment has contributed to a significant degree to that aggravation. If it is determined by the insurer that your injury did not occur in the course of your employment or is unrelated to your job, your claim may be denied. However, insurers can be wrong in their assessment so you should immediately seek legal advice if this happens.
This is often because of a lack of evidence and documentation demonstrating the connection between your injury and your work activities. If your claim has been rejected despite you believing the injury is work-related, it’s best to seek legal advice from a workers’ compensation lawyer. A lawyer will help you understand your rights to compensation for your injuries.
Not Using Your Own GP to Treat Your Injury
Your employer may request you to visit their preferred doctor for your work-related injury. However, you have the right to choose which GP you go to for treatment and advice. You should choose a GP you can trust and rely on. If you have a regular GP, they will also have a better understanding of your past medical history. This will make assessing your injuries easier and take less time, making your claim process smoother. So it’s ideal you visit your GP to treat and assess your injury before you begin making your claim.
Pre-existing Injuries or Illness
The presence of pre-existing injuries or illnesses can complicate workers’ compensation claims. Insurance companies may question whether your current injury is work-related. In such cases, the insurer might attribute your injury to the pre-existing condition and deny your claim.
If the workplace significantly contributed to the aggravation or recurrence of pre-existing injury or disease it is still considered a workplace injury. It’s crucial to provide thorough medical documentation and expert medical opinions that establish a clear link between your work activities and the aggravation of your condition.
Giving the Insurer Too Much Time After Issuing Pended Notice
When submitting your workers’ compensation claim to the insurer, they will either accept, dispute or hold the claim as ‘pending’. A pended claim is put on hold ‘until further investigations are carried out’, however, there is no further requirement for the insurer to do anything. Therefore the Act states that if the claim is not accepted 10 days after the date of their pended notice the claim is automatically in dispute. The insurer is not ‘required’ to investigate your claim any further. Generally, they do but not always. Your claim could technically be delayed indefinitely if you don’t force the insurer to respond after this timeframe.
What to do if Your Workers’ Compensation Claim is Rejected
If your workers’ compensation claim is rejected, don’t lose hope. You have the right to lodge your case with the Dispute Resolution Authority to seek a decision from an arbitrator. Start by reviewing the rejection notice thoroughly to understand the specific reasons for the denial. Consult with a workers’ compensation lawyer, who can help you navigate the dispute process effectively. Collect any further evidence and any supporting documentation, to strengthen your appeal. Presenting a compelling case and addressing any discrepancies or misunderstandings can significantly increase your chances of having the rejection overturned.
Do You Have a Delayed or Rejected Workers’ Compensation Claim?
There are plenty of ways for you to dispute a rejected claim, and we can help you out with it. If your claim has been denied, give Anvil Legal a call. Our workers’ compensation lawyers have the knowledge and experience needed to help you understand your rights to compensation and how to appeal a WorkCover claim.