WorkCover Claim Rejected in Queensland: What Injured Workers Can Do Next
If your WorkCover claim rejection decision in Queensland has left you stressed or unsure about your next steps, it is important to know that a rejected claim is not always the end of the road. Many Workers’ Compensation claims are lodged in Queensland every year. Although many applications are accepted and benefits are paid, some claims are denied. Under the Queensland statutory Workers’ Compensation scheme, injured workers may have options to request a review of the decision and, in some cases, appeal the outcome.
Why was my WorkCover claim rejected in Queensland?
Under the Workers’ Compensation and Rehabilitation Act 2003 (“the Act”), an insurer can deny a workers’ compensation claim for several reasons. Common workers’ compensation rejection reasons include the following:
The claim was lodged out of time
Generally, an injured worker has 6 months from the date of injury to lodge a claim with a workers’ compensation insurer. A failure to meet this time limit may result in the loss of a person’s entitlement to workers’ compensation. However, there are exceptions, so it is important to seek legal advice if the insurer has rejected your claim on this basis.
The person’s employment was not a significant factor in the injury
To be eligible for benefits under a Workers’ Compensation scheme, the injury must be related to a person’s work or have occurred during the course of employment. If the insurer does not believe the injury is work-related, for example, if the employer disputes the details of the incident, this could result in the rejection of an injured person’s application for compensation.
There is insufficient evidence to substantiate the claim
WorkCover Queensland, the workers’ compensation insurer established under the Act, generally has 20 business days to make a decision on your application. However, the insurer may require more time to undertake further investigations or obtain further information before making a decision. If the insurer determines there is not enough evidence, such as medical reports or Workplace Health and Safety records, to determine that the injury was work-related, it may refuse to accept a claim for compensation.
The injured person is not considered a worker under the Act
“Worker” is defined in the Act to mean an individual who “works under a contract; and in relation to the work, is an employee for the purposes of assessment for PAYG withholding”. If, after its investigations, the workers’ compensation insurer does not determine an injured person to be a worker under the Act, their application will most likely be rejected.
The psychological injury was caused by reasonable management action
In the case of psychological injuries, such as bullying or harassment claims, an insurer may reject the application for compensation if the injury was due to reasonable management action. You can learn more about this in our blog, “Am I being bullied or is it reasonable management action?”
What happens after a WorkCover claim is rejected?
Whether an insurer accepts or rejects your claim, it is required under the Act to provide written reasons for its decision. If the notice of a rejected claim for compensation does not include the reasons the application was denied, the injured worker can request this information. If you do not agree with the insurer’s reasons for denying your application, a lawyer can provide workers’ compensation legal advice in Queensland and guide you through your next steps.
Timeframe for a workers’ compensation claim review in Queensland
If a workers’ compensation claim is rejected and the injured worker wishes to have that decision reviewed, they have three months from the date of receiving the insurer’s written decision to request a review. It is crucial that claimants begin the review process without delay, as they will require time to collate relevant supporting information and evidence. We do not recommend that you pursue a review of a workers’ compensation decision without advice and assistance from an experienced lawyer. Reviews can be complex, and it is important that thorough and accurate information is submitted in a timely manner.
How is a workers’ compensation decision reviewed in Queensland?
If you have received an adverse decision about your workers’ compensation claim, including a rejected claim, an application for review must be lodged with the Workers’ Compensation Regulator. The Regulator is an independent authority and is separate from WorkCover and other workers’ compensation insurers. Review requests must be lodged either online, by post or by email using the appropriate claim review form. In addition to completing the form, written submissions stating your grounds for review and supporting documentation must be submitted as evidence.
Supporting documents may include witness statements, further medical evidence, Workplace Health and Safety records or other information that helps explain why the decision should be changed. The review process can include a right of appearance, which means you may be able to meet with the Review Officer in person, make representations over the phone, or provide information by another method. This provides an opportunity to highlight key matters from your written submissions. Reviewing a rejected workers’ compensation claim in Queensland can be complicated and stressful, so it is important to seek legal advice early.
What decisions can the Workers’ Compensation Regulator make?
There are three primary outcomes the Workers’ Compensation Regulator can determine:
- The Regulator can set aside the original decision and allow your workers’ compensation claim to proceed.
- The Regulator can uphold the original decision, meaning your claim remains denied.
- The Regulator can vary the original decision.
Can I appeal a WorkCover decision in Queensland?
If the Workers’ Compensation Regulator confirms the insurer’s decision to reject your application, you may have a further appeal option.
You can lodge an application with the Queensland Industrial Relations Commission. An appeal must be lodged within 20 business days of receiving the review decision. A WorkCover claim appeal can be complex and costly. It is vital that you seek legal assistance if you choose to appeal the WorkCover decision through the Queensland Industrial Relations Commission.
Get help from a workers’ compensation lawyer in Queensland
Although a rejected workers’ compensation claim may be challenging and frustrating, it is important not to lose hope. With avenues available to have a decision reviewed or, ultimately, appealed, there may be opportunities to protect your workers’ compensation rights and entitlements.
It is important to take proactive steps to protect these rights, including seeking legal advice early. Speaking with an experienced workers’ compensation lawyer in Queensland can give you the best chance of understanding the review process, gathering the right evidence and pursuing the compensation you may be entitled to.
Contacting Hall Payne Lawyers
You can contact us by phone or email to arrange your consultation, either face-to-face at one of our offices, by telephone or by videoconference consultation. If you are wondering what to do if your WorkCover claim is rejected in Queensland, need help with a workers’ compensation claim review in Queensland, or want advice on how to win a WorkCover appeal in Queensland, Hall Payne Lawyers can help you understand your options.
Rejected WorkCover Claim FAQs
What should I do if my WorkCover claim is rejected in Queensland?
If your WorkCover claim is rejected in Queensland, read the written reasons carefully, note the review deadline, gather supporting evidence, and seek legal advice before lodging a review application.
Why was my WorkCover claim rejected in Queensland?
A WorkCover claim may be rejected because it was lodged out of time, the insurer does not accept that work was a significant contributing factor, there is insufficient evidence, the person is not considered a worker, or the injury is psychological and said to arise from reasonable management action.
What happens after a WorkCover claim is rejected?
After a WorkCover claim is rejected, you may be able to request written reasons, seek advice, gather evidence and lodge a review application with the Workers’ Compensation Regulator within the required timeframe.
How do I appeal a WorkCover decision in Queensland?
If the Workers’ Compensation Regulator upholds the insurer’s decision, you may be able to appeal to the Queensland Industrial Relations Commission. Strict time limits apply, so legal advice should be sought promptly.
How can I improve my chances in a WorkCover appeal?
While no outcome can be guaranteed, strong evidence can assist. This may include medical evidence, witness statements, incident records, employment documents and clear written submissions explaining why the original decision should be changed.