Receiving a denial letter for a workers’ compensation claim can be overwhelming, especially when you’re counting on support to manage expenses after a workplace injury. Many workers assume that a denial is the end of their claim, but it’s often just the beginning of the next step. Knowing the reasons why claims are denied, and how you can challenge these decisions, can make all the difference.

Carbone Lawyers has over 30 years of experience in Victorian workers’ compensation cases, successfully guiding clients through complex claim processes and dispute resolutions. With an empathetic, client-first approach, we’re here to support you in fighting for the compensation you deserve. Below, learn about the most common reasons claims get denied, the steps you can take to dispute a denial, and the benefits you may be entitled to under a successful claim.

Why Your Workers’ Compensation Claim Might Be Denied

Workers’ compensation claims can be denied for a range of reasons, often due to technicalities or documentation issues that can be challenged with the right approach. Here are the primary reasons WorkCover may deny a claim:

• Worker Status: Not everyone qualifies as a “worker” under Victorian law (WorkSafe Victoria: Worker Arrangements). If you’re a subcontractor, volunteer, or part-time worker, you may face additional scrutiny to prove your eligibility. Many claimants are surprised to find that their employment status impacts their claim, even if they perform work for a company regularly.
• Workplace Connection: For a claim to be approved, your injury or illness must be directly connected to your job. Claims may be denied if there isn’t clear evidence linking the injury to work duties or the work environment. For instance, if the injury happened offsite or during a break, you may face challenges proving it’s work-related.
• Reasonable Claimed Expenses: Sometimes, WorkCover denies claims based on the “reasonable nature” of the compensation requested (WorkSafe Victoria: Treatment expenses), particularly if it deems medical expenses or lost wage claims excessive. Without detailed documentation and justification, even valid expenses can be disputed.
  
  

If your claim was denied for one of these reasons, know that you have options. Many denials can be successfully overturned by addressing the specific issues WorkCover flagged.

What to Do if Your Workers’ Comp Claim is Denied

A denied claim is not the end. In Victoria, workers have the right to dispute WorkCover’s decision through the Work Injury Commission (WIC), but timing is crucial. You have 60 days from receiving the denial to file a dispute, so it’s essential to act quickly.

Here’s how Carbone Lawyers can help if your claim was denied:

• Case Review and Documentation: Our team will thoroughly review your claim, identifying gaps that may have led to the denial. We work with you to gather the necessary documentation, ensuring that your case meets all WorkCover requirements.
• Filing the Dispute: We handle all communications with WorkCover and WIC, filing your dispute within the legal timeframe and managing every step of the process.
• Representation at Hearings: Should your case go to a WIC hearing, we provide full legal representation, advocating for your rights and building a strong argument to maximise your chances of a favourable outcome.

Our case files show that workers who challenge denials with legal representation often achieve better results. Don’t let a denied claim discourage you; disputing could open the door to the compensation you deserve.

Dealing with an Employer Dispute on Your WorkCover Claim

In some cases, your employer may challenge your WorkCover claim, disputing that your injury is work-related or questioning the circumstances. These disputes can feel intimidating, but you have rights.

Employers can legally dispute a claim under certain conditions, but they cannot harass or unfairly treat you for making a claim. We provide the support and representation you need to handle employer disputes, ensuring that your rights are respected.

Our experienced lawyers know how to navigate employer challenges, collecting the necessary evidence and presenting your case effectively to WorkCover and WIC if required. With our team on your side, you can approach an employer dispute confidently, knowing that you have strong, experienced advocacy.

Your Entitlements Under a Successful WorkCover Claim

What does winning a WorkCover claim actually mean for you? If your claim is successful, you may be entitled to compensation that can cover various expenses and financial needs.

• Income Payments: WorkCover provides income support if you’re unable to work or can only work reduced hours. You may receive 95% of your pre-injury average weekly earnings (PIAWE) for the first 13 weeks (WorkCover Victoria: PIAWE), then 80% until 130 weeks (WorkCover Victoria: Weekly Payments). In certain cases, these payments can extend beyond 130 weeks.
• Medical and Rehabilitation Costs: Approved claims can cover reasonable medical expenses, including doctor’s appointments, physical therapy, and even transportation costs. WorkCover may also cover permanent modifications to your home, if required, for your recovery (WorkCover Victoria: Home Modification).
• Lump Sum Impairment Benefits: If you’ve been off work for 12 months and meet the necessary criteria, you may be eligible for a lump sum impairment benefit (WorkCover Victoria: Permanent Impairment), based on the severity and impact of your injury.

Knowing these entitlements can give you a clearer understanding of why it’s worth disputing a denial. We are here to guide you through each of these benefits, making sure you receive everything you’re entitled to under the law.

Get Expert Help with Your Workers’ Compensation Dispute

With Carbone Lawyers, you have access to a team that brings decades of experience and a track record of success in handling workers’ compensation disputes. Our expertise and compassionate approach ensures that you’ll be supported at each stage, from gathering documentation to representing you in hearings. If you’re unsure about your current claim or have been disappointed by a denial, we can provide the guidance and advocacy you need.

Don’t Settle for Less: Contact Carbone Lawyers

A denied claim doesn’t have to be the end of your workers’ compensation journey. Whether your claim was denied due to documentation issues or you’re facing an employer dispute, we have the experience and commitment to help you.

Contact our team for a free consultation to discuss your options and see how we can support your path to fair compensation. Call 1800 369 888 or complete our online assessment form to connect with a workers’ compensation expert today.