WorkCover Claim Rejected

Has your WorkCover claim been rejected? It can be hard knowing the next steps to take – especially when you are already dealing with the challenges of an injury. Sometimes, claimants who are eligible for the compensation they have claimed for have their WorkCover claim rejected. Often, the reason for your WorkCover claim being denied isn’t clear so it can be difficult to know how to dispute the decision. WorkCover claim disputes can also be complex so seeking legal advice is important. 

Here is what you can do if your WorkCover claim is denied, what types of decisions are reviewable and how our team of experts can help you if your WorkCover claim has been rejected to give you the best chance of a successful outcome:

What Do I Do If My WorkCover Claim Is Rejected? 

If your WorkCover claim is denied, you can challenge decisions a WorkCover insurer makes that you disagree with at the Workplace Injury Commission.

Examples of challengeable decisions:

• Rejection of a WorkCover claim.
• Restriction or termination of medical expenses generally or particular types of treatment.
• Termination or reduction of weekly payments.
• Return to work or rehabilitation planning.
• Failures by the insurer to make decisions when asked.

Referrals to conciliation must be made within 60 days of the WorkCover insurer’s decision, but extensions may be available in some circumstances. Lawyers are not usually allowed to attend conciliation, but Union Assist or WorkCover Assist can be arranged to represent you at a conciliation conference, and we will still provide advice about the process and your options.

Worker’s Compensation Independent Review Service (WCIRS)

WCIRS is a team within the Independent Review division of the General Counsel’s office at WorkSafe Victoria, set up to provide a free and impartial review of certain disputed reviewable decisions that do not resolve at conciliation.

An independent review of a reviewable decision can be requested after it has been through conciliation at the Workplace Injury Commission and where a Genuine Dispute Outcome Certificate has been issued. It must be:

• Within 2 years of the Genuine Dispute Outcome Certificate being issued; and
• Before a court listing the matter for a final hearing or referral to the Medical Panel

What decisions are reviewable?

• An agent’s decision not to accept a worker’s primary claim;
• A decision to stop, suspend, or refuse to pay weekly payments;
• A decision about the calculation of weekly payments;
• A decision about whether the worker has or does not have a current work capacity;
• A decision relating to medical and like services;
• A decision about the calculation of weekly payments;
• A decision about whether the worker has or does not have a current work capacity.

What decisions are not reviewable?

• No Genuine Dispute certificate;
• A worker’s degree of impairment;
• Relating to the death of a worker or their dependent;
• A Medical Panel decision;
• A decision that has been settled by agreement between the agent and worker; 
• A decision made by a self-insurer; and
• Relating to Serious Injury or Common Law damages

Our WorkCover lawyers have an in-depth knowledge of WorkCover claim disputes and utilise this to build a strong case on your behalf. We can guide you on the best course of action to take, assist you in making an application to WCIRS for a reviewable decision and will keep you informed along the way. Our focus is on taking the stress out of an already challenging time for you and ensuring the compensation you’re entitled to is achieved. 

Talk to Us About Rejected WorkCover Claims Today

If your WorkCover claim was denied contact us today to speak with one of our WorkCover claim lawyers.  Call 1800 369 888 or fill out our online enquiry form and we will respond to your enquiry as soon as possible.

For over 30 years Carbone Lawyers has been achieving successful outcomes for our clients. We are renowned for our Personal Injury Law expertise and have a team of highly skilled lawyers experienced in WorkCover claims that have been rejected, driven to ensure you get the compensation you are entitled to. We also have a No Win, No Fee policy for those claiming compensation for injury or illness which means that most personal injury claims have no upfront fees.