Workers Compensation Claims – Are they worth appealing?

10 January 2024|blog whs-blog

Workers Compensation Claims, are they worth appealing? Yes they are! And here at HR Business Direction, we have appealed a number of claims and been successful. Of course, it is only worth it (and appropriate) if you genuinely know or have information to the contrary of what is being claimed.

Prior to having to appeal a workers compensation claim though, it is worthwhile to provide WorkCover (if in Queensland and not self-insured) with as much information as possible when the claim is made as part of the Employer Response. It is worth investing time, energy and money (in those that have had experience in this area) as a successful outcome. It is also best if you can to do this during the claim lodgement phase, prior to a decision being made. If unsuccessful at this claim phase, you can still appeal.

If you do have to appeal a decision already made however, you would need to seek and consider the reasons for the decision before proceeding. From a pure financial perspective however, with an increase in premiums based on successful claims it is certainly worth consideration. For some interesting statistics for you, in 2021-22, 236 appeals were lodged and in 2022-23, 188 appeals were lodged with the Queensland Industrial Relations Commission. (Office of Industrial Relations, Queensland Workers Compensation Scheme Statistics 2021 – 2022 and 2022 – 2023).

Again, if there is sufficient evidence to suggest the employer is not to blame or the injury / illness didn’t arise from reasonable management action undertaken in a reasonable way and work wasn’t a significant contributing factor. Another reason to appeal, aside from the financial aspect, is you don’t want fraudulent or frivolous claims being made from others in your business.

The no fault statutory system has limited resources for claim investigation and generally make a decision based on the information provided by the employer, employee and medical professionals. Again, obviously if it is a genuine claim, you wouldn’t appeal or fight the claim, however, it is still best to give the insurer as much relevant information as possible for the insurer to make a decision. And with a 3.8% rejection rate in 2022 and 4.8% in 2023 for physical claims and a 50.3% rejection rate for in 2022 and 47.2% in 2023 for psychological claims (according to Office of Industrial Relations, Queensland Workers Compensation Scheme Statistics 2021 – 2022), getting assistance from professionals who understand the system, the legislation and the language is a good idea. As an example, we saved an employer $50,000 via a successful claim review for a psychological injury claim. In this example, Workcover’s decision was set aside for them to complete further investigations. They then rejected the claim in our clients favour, see further detail here.

When providing information, it is important to be objective and respectful to the injured person. They will have an opportunity to respond to the information provided prior to the insurer making a decision. You may disagree, but a successful return to work can be facilitated and reduce claims costs and the impact on premiums (which is impacted by the cost of claims history). There is much to be gained by maintaining sound employer / employee relationships following an injury and / or claim, regardless of whether you agree or not or appeal or not – another good reason for having professional assistance.

It would also be amiss of me not to mention that in fact, prevention, however, is key for any injury or illness to prevent a claim being made in the first place. This can be done through good communication, good HR practices, positive culture, great leadership and a focus on health and safety including psychosocial safety.

At HR Business Direction we can assist with Workers Compensation employer responses and appeals. Don’t leave it too late to reach out. Contact us here.

Leisa Messer BBus(HRM); GradDipIR; CAHRI; IRSQ
Managing Director | HR Strategist
leisa.messer@hrbd.com.au
07 3890 2066
www.hrbd.com.au