Everything you need to know – Appealing a Workers Compensation Claim

So your insurer has made a decision about a workers compensation claim, but you disagree with it. What do you do?

The easiest way to avoid having to appeal a claim decision is to the insurance company directly, by providing them with as much information as possible regarding the claim. This is most successful when made during claim lodgement and prior to the decision being made on the claim.

But what if the insurer has already made a decision?

Many people would just stop there, believing that there isn’t anything more they can do. Insurance companies are the be-all and end-all right? Well, in actual fact you have every right to review a decision made by insurers. In Queensland, by going through the Queensland Government Workers’ Compensation Regulator, both employers and employees can review a decision they disagree with.

Why should I review the decision?

You may have many reasons for reviewing a decision, but at the end of the day, the reasons must be those that are considered grounds for review by the regulator.  The main reason for reviewing a claim decision is if you believe you have sufficient evidence to the contrary of the claim. Other reasons might include disagreeing with interpretation of information considered in relation to the claim and concern regarding the lodgement of a future common law claim.

After an employee makes a claim, it is most probable that it will affect your workers compensation premium by increasing it substantially. Successfully reviewing a claim decision can potentially save your business a lot of money.

How do I review a decision?

If you have to review a claim once the insurance company has made a decision, that’s where the Workers’ Compensation Regulator comes in.

The Workers’ Compensation Regulator is an independent entity and in Queensland is not part of WorkCover Queensland or a self-insurer. It is an independent decision maker and (for the most part) a free review service.

But collecting all the supporting information and jumping through the hoops is where you may find the process time and money consuming, particularly if your HR/WH&S department is overworked already or simply don’t have an in-depth knowledge of workers compensation, the process or experience.

One of the easiest ways to avoid this is to enlist the help of a management consultant with a workplace health and safety and workers compensation specialty and experience.  By outsourcing the review process to them, you can focus on more pressing matters within your HR department or WH&S Department, and can aid in maintaining the employer and employee relationship.

How long does it take?

Exact times may vary, but The Workers’ Compensation Regulator is required to make decision within 25 business days of a review request being submitted.

Compiling all the information required for the review also depends on the situation, the claim, and the industry you are in.

Instead of worrying about the outcome over that time, having a management consultant with workplace health & safety and workers compensation specialty and experience overseeing the process ensures you know your appeal is in the best hands possible.

What will the outcome be?

The outcome varies from business to business and claim to claim, but lodging review is the only way you’ll have a chance of receiving the outcome you desire. Whether successful or not, you can save yourself time and a great deal of headaches by leaving the appeal in the hands of Specialised professionals.

At HR Business Direction, our WH&S / Worker Compensation specialists are able to assist you with workers compensation claims and reviews. 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