Monaco Compensation LawyersMonaco Compensation Lawyers
Call Menu Close
    Search Cross
    Close
    Viewing content for gps Australia
    Contact us
    Monaco Compensation Lawyers
    1300 769 665Contact us
    Search
    Search
      close
      Search
      Close
      Viewing content for gps Australia

      What Happens if My Workers Compensation Claim is Denied​?

      Quick answer

      If your workers compensation or Workcover claim is denied, your insurer must send you a letter outlining the reasons they denied the claim. You can then appeal their decision. In most states, you will be required to first participate in negotiations with your insurer. Your claim will only proceed to court if these negotiations fail.

      Overturning insurer decisions is a complex process and requires a skilled understanding of workers compensation law. An experienced lawyer can handle negotiations on your behalf and ensure you receive a fair outcome.

      For information on challenging denied workers compensation claims in NSW, Queensland and Victoria, see our comprehensive guide below.

      In depth answer

      Your workers compensation claim can be denied for many reasons. The most common reasons an insurer may list are:

      • You are not a ‘worker’ under your state legislation.
      • Employment was not a substantial contributing factor to your injury.
      • It was not ‘reasonably necessary’ to have medical treatment or other claim-related expenses.
      • Your injury happened outside of work.
      • Your injury is pre-existing.
      • Your claim was made outside your state’s time limit.
      • Your employer disputes your account of the injury.

      You are entitled to challenge a denied workers comp claim. How you do so depends on the state you’re claiming in.

      We strongly suggest speaking to an expert lawyer before challenging a denied claim. Insurers are well-resourced and denied claims are notoriously complex. But with over 25 years’ experience in workers compensation claims, our specialist lawyers know the appeals process inside out. We’ll handle all the forms, collect fresh evidence, and quickly get your denied claim overturned.

      Different laws apply in different states. Please choose your state below so we can show you the most relevant content.

      If your workers compensation claim is denied in NSW, your insurer must outline their reasons in a written ‘section 78’ decision notice.

      What happens if my workers compensation claim is denied?

      If your workers compensation claim is denied, your first step is to request a review from your insurer. Your insurer should provide a review form for you.

      We suggest speaking to a lawyer at this point. They will explain the dispute notice and help you request a review. Your lawyer will also gather evidence to support your case and guide you through the next steps. What those steps entail changes from case to case. They will depend on both the nature of the dispute and the reasons your insurer rejects your claim.

      After you have requested a review and taken all the necessary steps, your insurer will respond. The response must be in writing and within 14 days of receiving your request. You may be required to make further submissions, be examined by your insurer’s doctor, or provide further medical evidence.

      In the end, your insurer will either overturn or modify their original decision, or maintain it. There are still options available even if your review is rejected. Our workers compensation team have decades of experience overturning denied claims.

      If your Workcover claim is denied in Queensland, your insurer must provide a letter explaining why your claim was denied. Workcover Queensland representatives may also call to discuss your denied claim.

      What happens if my Workcover claim is denied?

      If your Workcover claim is denied, you have 3 months to request a review of the decision through the Office of Industrial Relations. Your review will be undertaken by a review officer working with the workers compensation regulator.

      The review officer will re-examine your claim. They do not re-investigate your application and will never request further information.

      It’s important to know that certain insurer decisions cannot be reviewed. You must instead appeal the decision directly to the Queensland Industrial Relations Commission (QIRC). These include decisions:

      • Not to fund a particular medical procedure.
      • Regarding the ongoing management of the application for compensation.
      • Not to apply the premium discount.

      If you are unhappy with the result you can challenge the review. This results in a second review where the results are final. If you wish to challenge the decision again, you must appeal to the QIRC within 20 business days.

      An appeal to the QIRC requires both you and the insurer to make submissions to the court. We suggest engaging an experienced lawyer before starting your appeal. Our team are Workers Compensation specialists and have successfully overturned hundreds of insurer decisions.

      Workcover Victoria must provide a clear explanation for rejecting your claim. Make sure to carefully review the rejection letter to identify the exact reasons for the denied claim.

      What happens if Workcover rejected my claim?

      If your Workcover claim is rejected in Victoria, you’re entitled to challenge the decision. To do so, you’ll need to request an internal review of the decision by WorkSafe. You usually have 60 days from the date of the rejection letter to request this review.

      If you’re not happy with the results of the internal review, you can take your case to the Accident Compensation Conciliation Service (ACCS). Conciliation is a free, informal process designed to resolve disputes between injured workers and insurers.

      If conciliation doesn’t resolve the dispute, you can file a legal claim in the Magistrates Court. This process can be costly and time-consuming — so even if you’ve come this far without a lawyer, it’s important to speak to one before heading to court. Our workers compensation lawyers are experts in appealing denied Workcover claims and will provide free advice on all your options.

      Other popular questions

      See all FAQs

      Free Claim Advice

      Speak to an expert lawyer about your situation today.

      Make an enquiryCall 1300 769 665
      Google
      4.8/5
      StarStarStarStarStar
      Based on 266 reviews on Google

      Get free claim advice

      We offer a free consultation to assess your case, explain your options, and answer your questions. It's fast, confidential, and obligation-free.

      Call 1300 769 665Email us