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Dealing with WorkCover: Next Steps if Your Claim is Rejected or Payments Cease

Dealing with workcover

At ROC Legal we have extensive experience in handling workers’ compensation claims in Queensland, We have seen countless cases where injured workers face the daunting prospect of having their claims rejected or their payments unexpectedly ceased by WorkCover. This article aims to guide you through the next steps you can take if you find yourself in such a situation.

Understanding the Reasons for Rejection or Cessation of Payments

It is essential to understand the common reasons why WorkCover may reject your claim or stop your payments. Some of these reasons include:

1. Not being considered a ‘worker’ under the Workers’ Compensation and Rehabilitation Act 2003
2. The injury occurring outside of work hours
3. Failure to properly report the incident to your employer
4. Lodging the claim outside the required timeframe (6 months from the date of injury)
5. Filing the claim in the wrong jurisdiction
6. For psychological injuries, WorkCover may argue that the condition was caused by ‘reasonable management action’ taken by the employer

It is crucial to note that receiving a rejection letter does not necessarily mean that your claim is invalid. Many injured workers fail to review the decision or wait too long to do so, despite potentially having a valid claim.

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Applying for a Review of WorkCover’s Decision

If your claim has been rejected or your payments have been ceased, you have the right to dispute the decision by applying to the Workers’ Compensation Regulatory Services for a review. In Queensland, you must lodge your review request within three months of the decision. Failing to meet this deadline may result in losing your opportunity to challenge the decision unless you can demonstrate special circumstances that prevented you from meeting the timeframe.

When applying for a review, it is highly recommended that you seek legal advice from a specialized compensation lawyer. At ROC Legal, we understand the complexities of the workers’ compensation system and can guide you through the process, ensuring that your rights are protected and that you have the best possible chance of a successful outcome.

The Review Process

Once you have submitted your review request, the Workers’ Compensation Regulatory Services will generally make a decision within 25 business days, unless an extension has been agreed upon. You will receive a written decision within 10 days of the decision being made.

There are several possible outcomes following a review of your claim decision:

  1. Win: The original decision of WorkCover is dismissed
  2. Lose: The original decision of WorkCover is upheld
  3. Variation: A variation is made to the original decision
  4. Information/Directions Required: Further information or directions are provided to the parties

If you have medical appointments or documents that will not be available before the expiration of the review timeframe, it is advisable to submit the application without them, obtain compliance, and then provide the additional information once it becomes available.

Appealing the Review Decision

If the review decision upholds WorkCover’s original decision, you still have the option to lodge an appeal with the Queensland Industrial Relations Commission. The appeal must be lodged within 20 business days of receiving the review decision.

Upon lodging a Notice of Appeal, the Commission will issue directions for the management of the appeal, including due dates for filing and providing documents to other parties and scheduling a conference or hearing.

The Importance of Legal Representation

Navigating the workers’ compensation system can be a daunting and emotional task, particularly when you are already dealing with the physical and mental toll of a work-related injury. Engaging a compensation lawyer from ROC Legal can make a significant difference in the outcome of your case.

Our experienced lawyers can:

  1. Review your case and advise you on the best course of action
  2. Assist you in gathering the necessary evidence to support your claim
  3. Represent you during the review and appeal processes
  4. Negotiate with WorkCover and other parties on your behalf
  5. Ensure that you receive the full entitlements and compensation you deserve

We understand that dealing with WorkCover can be frustrating and overwhelming, especially when your calls go unanswered or your benefits are unexpectedly terminated. Our goal is to support you every step of the way and fight for your rights as an injured worker.

Potential Common Law Claims

In addition to your statutory workers’ compensation claim, you may also have a common law claim for damages for negligence against your employer. However, in most cases, this type of claim cannot proceed unless your statutory compensation claim is accepted by WorkCover.

Our team at ROC Legal can assess your case and determine whether you have a valid common law claim. We will guide you through the process and work tirelessly to ensure that you receive the compensation you deserve for your injuries and losses.

Dealing with a rejected workers’ compensation claim or the unexpected cessation of your payments can be a stressful and overwhelming experience. However, it is essential to remember that you have rights and options available to you.

By seeking the assistance of a compensation lawyer from ROC Legal, you can ensure that your case is handled professionally and efficiently. We will work with you to gather the necessary evidence, meet the required deadlines, and represent your interests throughout the review and appeal processes.

Check if you’re eligible for a Compensation Claim

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