What happens when your claim is accepted

A Workers Compensation claim form must be filled in and handed to your employer, along with your doctors WorkCover initial 14 day certificate of capacity.

This doctor’s certificate will have either; a no work capacity or a reduced work capacity/ restrictions, meaning you are unable to do your normal work. Remember you are not on WorkCover benefits until your claim has been accepted and you are issued a claim number.

Once your claim has been accepted, you must keep getting medical certificates every 28 days from your doctor to show you cannot work, or that you still have restrictions on your ability to work.

Certificates must be given to your employer, who passes them on to the insurer. The insurer then pays the compensation to your employer, who pays you.

It’s important to note that if your employer goes bankrupt or you are seriously injured and you have been off work for 52 weeks, your claim will be taken over by the Insurance Company handling your claim. You then send your certificates and all medical expenses to the insurance company, instead of your employer.

It is a good idea to photocopy your certificate twice. Send the original to your employer and a copy directly to the insurer in case there is any delay in your employer passing it on. Keep the other for your own records.

The certificate of capacity must be ticked to indicate if you are unable to work or you are on restricted work. You must sign as well as your doctor for payments to be paid into your bank account.

Has your WorkCover claim been rejected?

Disputes – What if I am unhappy with a WorkCover decision?

Conciliation - ACCS

Any decision made by a WorkCover insurer may be referred to conciliation. Conciliation is meant to be a process controlled by the independent conciliator which allows discussion of the dispute. The conciliator tries to find a way to resolve the dispute, but has only limited powers to make a binding decision.

You do not need a lawyer to go to conciliation, but it’s a good idea to get help. Your union should be your first port of call, additionally Union Assist will be able to help you.

Simply put, if your claim is rejected, your first actions should be:

1. Within 60 days of the decision being notified to you, complete a Request for Conciliation form. There’s also a checklist to make sure you’re filling in the form with all the details you need to.

1. Send the form and any medical reports supporting you, and a short written summary of what should happen and why, to the Accident Compensation Conciliation Service.
2. A date for a conciliation meeting will be set, and you will be notified.

Who can assist you?

• Union assist
• Your union may have a WorkCover officer, or at the very least someone knowledgeable about WorkCover
• A friend or someone else with experience in the ACCS system.
• Solicitors are not usually allowed into the ACCS conference.
• The Injured Workers Support Network

Can I appeal to Court?

Yes. If conciliation is unsuccessful, you may issue proceedings in the Magistrates Court or County Court.

If you are not happy with a conciliation outcome, seek legal advice. There are a number of legal firms the offer No Win No Fee arrangements to try to have the rejection of your claim over turned.

If you are successful you are entitled to back payment from the date of the injury. This will also have an interest component added to the payment.

Sometimes medical questions are referred from conciliation to a Medical Panel. A Medical Panel is made up of a number of doctors who will read the documentation, examine you and make a decision on the medical question/s which are binding on the parties and on the Court.

Medical Expenses

In the initial stages of your claim you can claim all medical expenses related to your injury once you have a claim number. Receipts are passed on to your employer for reimbursement.

You can choose who provides services to you but WorkCover can only reimburse you for services provided by a WorkCover accredited provider. There may also be an out of pocket fee, as Worksafe have a fixed fee on these services.

You can also claim for travel expenses when you see your own treating doctors and when you are sent to doctors by WorkCover.

Home Help Services

You may also claim for home help, cleaning of your house, help in the garden or for serious Injuries, you may require modifications to your home and car, where necessary. You should discuss these needs with your doctor, who can provide a letter to the insurer setting out your special needs.

Once your income payments stop and a year has passed, the rules for claiming medical expenses change. There are exceptions, but in general if the service is essential to ensuring that your health and lifestyle are maintained, or you need treatment to stay at work, WorkCover remains liable.

Rehabilitation

Your employer is required to help you design a rehabilitation and return to work plan, preferably with a rehabilitation provider.  You must take all reasonable steps to participate in rehabilitation and to return to work. If you do not make reasonable attempts to return to work, your benefits can be stopped.