The Workers’ Compensation claim process explained

Many people who are injured at work go through a period of uncertainty while they wait for their compensation claim to be assessed. Some feel as if they have nowhere to turn, and those who are off work without pay may start to become anxious about financial matters.

We’ve written this article to reassure people who have injured themselves at work that they’re not alone. Every year, hundreds of workers find themselves in a similar situation to the one outlined above. It’s important that they know that there are services like ours – as well as many other non-legal services, such as unions – ready and willing to help.

We’ve also put together this article to remove some uncertainty by taking you through what might happen during a workers’ compensation claims process, from the time you’re injured all the way through to a resolution.

When should I consider making a claim?

If you suffer any sort of loss as a result of your injury at work, whether that be time off work, a financial loss due to rehabilitation or medical expenses, or if you undergo physical or emotional stress (what’s often referred to as “pain and suffering” in the legal system), you should consider making a claim.

What should I do after I’ve been injured at work?

No matter how minor your injury may seem, it’s important that someone at your place of work knows that you were injured, how you were injured and when you were injured. This should be recorded in a formal incident report, but at the very least, make sure somebody knows what has occurred. Don’t keep your injury to yourself, even if you think it’s not a big deal.

If the injury is serious or requires medical attention, you’ll need to visit a doctor or medical professional and get a certificate.

What sort of medical certificate do I need?

You’ll require a Certificate of Capacity (sometimes known as a WorkCover Certificate), which is different from a standard medical certificate that you might get from a doctor for a cold or sporting injury that’s kept you off work.

A Certificate of Capacity is a document that states your diagnosis and prognosis, as well as your fitness for (or reduced capacity to) work.

If a doctor doesn’t issue you with a Certificate of Capacity, it may be because they are not familiar with the claims process (in which case you or your lawyer should specifically ask for one) or because they don’t believe your injury is serious or related to a workplace incident.

What should I do after I get the Certificate of Capacity?

Once you have been issued with a Certificate of Capacity, you should give your supervisor, manager or a member of the human resources team a copy of the certificate. The certificate indicates how serious your injury is, as assessed by a medical professional, what medical requirements you’ll need in the future and if you can continue to work.

Your employer should notify their insurer at this point, telling them that a workers’ compensation claim may be lodged.

What happens after the insurer gets involved?

Once an insurer has received notification from an employer that a claim has been lodged, a two-step process begins:

• Provisional acceptance or denial of liability
• Formal acceptance or denial of liability

Provisional liability means that the insurer has looked at the circumstances and facts of the claim and determined that “on the face of it, we should accept / deny this claim”.

If they accept provisional liability, you’re entitled to 12 weeks of pay as well as medical expenses up to $7,500 while you wait for their formal decision.

What happens after the provisional liability decision?

After a provisional determination has been made, the insurer will collect further information, including documentation and potentially further expert medical opinions, to determine a formal acceptance or denial of liability.

At this point, we always suggest that clients are as open and honest as they can be and give the full version of events during this period.

Once the insurer has completed their investigations, they’ll make their formal liability decision. If the claim is accepted, you will receive compensation based on a set formula (which differs from state-to-state).

The claim can also be denied (or certain aspects of treatment might be denied).

When should I get legal advice?

As soon as you feel like you need some help or advice, or your employer or their insurer isn’t cooperating in the process, you can contact Slater and Gordon for obligation free assistance.

If your claim has been rejected, and you believe it has been rejected unfairly, then this is also certainly a good time to seek independent legal advice.

Lawyers can speak with doctors, insurers, medical experts, witnesses to the incident and any other people involved in the process. In the case of Slater and Gordon, we offer a no-obligation, free first consultation and No Win – No Fee* service.

_{*Conditions apply. See: www.slatergordon.com.au/firm/legal-costs/no-win-no-fee}