Help! My NSW workers’ compensation claim has been rejected. What do I do?

Being injured at work is traumatic for you and your family. You may need to take an extended period off work, and in some cases, you may not be able to return to your job. During this difficult time, you should be focusing on your rehabilitation. The stress of worrying about money and being able to support your family shouldn’t impact on your ability to recover. Workers’ compensation provides important financial support if you are injured or become ill at work. When everything runs smoothly, claimants receive the money they need for various expenses to cover day-to-day costs and rehabilitation efforts, if necessary. For serious injuries or illnesses, insurers may even pay out a lump sum for permanent impairment. However, this is not necessarily the case for everyone. In some instances, eligible claimants can have their claims rejected. It’s important to know that if this occurs, the rejection doesn’t necessarily mean the end of the road for your claim. This blog looks at the reasons why your claim might be rejected, and what your options are going forward, including the process for lodging a dispute or appeal in NSW.

So your claim has been rejected – don’t despair​

Your approval or denial will come in the form of a decision letter from the workers compensation insurer. If your claim has been rejected, we know this can be tough. Don’t be disheartened – there are other options!

These include disputing or appealing the rejection. If you haven’t spoken to or engaged a legal representative already, you are entitled to do so for the dispute process.

Additionally, you may be eligible to make an income protection claim or a total and permanent disability (TPD) claim. Read more here: Workplace injuries and TPD claims – Littles

Why are workers’ compensation claims rejected in NSW?

Common reasons for which a workers compensation claim might be rejected in NSW include:

· the person making the claim does not meet the legal definition of ‘worker’

· the illness or injury wasn’t entirely work related

· no one saw what happened/saw the person get injured

· the person making the claim did not report the accident or incident to a supervisor immediately

· the person making the claim failed to follow the proper steps for filing the claim, and/or

· the person making the claim didn’t supply evidence of their injury.

Even if these are the reasons that have been cited by the insurer for your claim being rejected, it does not mean that they cannot be challenged, or that the insurer is not wrong.

What is the process for lodging an appeal or dispute in NSW?

To lodge a dispute in NSW, you must first submit a claim with the relevant workers’ compensation insurer – you can find those here on the website of the State Insurance Regulatory Authority (SIRA), which regulates workers compensation insurance in NSW.

1. Contact the insurer to request a review of their decision. The workers compensation insurer should send you an application form so you can explain why you feel a review is necessary. This is a good opportunity to provide the insurer with any additional information that may be relevant to your claim. The insurer then has 14 days to respond, at which point it can either affirm its original decision, or approve your claim.

2. If your claim is rejected by the workers compensation through the internal review process, you or your legal representative can lodge a dispute application through the Personal Injury Commission’s online portal. The Commission is designed to resolve claims in a less formal way than court proceedings. It is important to note that your application must be accompanied by all of the relevant information you intend to rely on. Remember: you may not be allowed to provide more information later on, so make sure you double check everything. After the Commission has received the application and information, it will assign the dispute to the most appropriate dispute resolution pathway, before making a decision. The decisions of the Commission in workers compensation matters are generally final and binding on all parties, with some limited exceptions. Most applicants to the Commission are legally represented, as it is generally their last chance to make a successful claim.

Don’t delay – seek advice now

Clearly, the workers’ compensation system can be complex, which is why it helps to seek quality legal advice as soon as possible. At Littles, we are experts in workplace injuries, and can help manage the process to ensure that you receive all appropriate entitlements and support. With Littles on your side, we can ensure that you get the fair treatment you deserve.

If your workers’ compensation claim has been rejected, or you would like to understand how to claim benefits to support you and your family while you are injured or ill, please get in touch for a no-obligation chat.

IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly.

Free advice and no upfront fees

Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.

The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice.

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