The process of challenging a WorkCover decision in Victoria
Published on Posted onPlease note that this post was written for Victorian audiences and the information within may not apply to other regions.
Sustaining an injury at work can have a significant impact on your life, presenting you with not only physical injuries, but also psychological and financial stress. The last thing you need is your WorkCover claim being rejected.
What can you do if your claim is rejected?
WorkCover is the primary authority responsible for your entitlements, such as weekly payments, medical expenses, or lump-sum claims. If one of Workcover’s insurers makes a decision you do not agree with (examples include: rejecting your claim or denying your request for physiotherapy) you are able dispute and challenge that decision.
How to dispute a WorkCover decision
1. Review the decision.
The first step in attaining a successful appeal is to ask the insurer to undertake an internal review of the decision. Simply calling them or informing them to do so will suffice. It is always worth attempting to resolve your dispute in the easiest and most efficient manner to save wasted costs and time.
2. Conciliation
Your next option is to complete and lodge a request for a conciliation with the Workplace Injury Commission. Your matter will then be set down for a conciliation conference. Usually, conciliation is held over the phone, but is also able to occur in-person.
Conciliation is an opportunity for the insurer to hear your side of the story and reasons for why you disagree with their decision. Conciliation is an informal, free and private method for resolving a dispute at the earliest possible stage.
The conciliator has the power to refer your matter to the medical panel (discussed below) or to issue a certificate which enables you to take your matter to court.
3. Referral to the Medical Panel
A referral to the Medical Panel would involve you attending an appointment with a few doctors (usually 2-4) who are tasked with independently assessing and deciding on your injury or any disputed medical questions.
Given the Medical Panel comprises solely of independent doctors, they are unable to determine any facts in dispute. Examples of a fact in dispute could include: the insurer taking the view that your injury occurred in another way and not at work.
4. Proceed to the Magistrates’ court
Another pathway to dispute an insurer decision following the conciliation process is to proceed to the Magistrates’ Court.
It is vital to obtain legal advice if making an appeal at court, in order to navigate the complex judicial system and regulations associated with disputing your claim.
To initiate matters at the Magistrates’ Court, specific paperwork must be file with the court, who will then set the matter down for a directions hearing in the first instance and then potentially for hearing. It can take several months from issuing proceedings before you get to your hearing.
At Zaparas Lawyers, we understand the process of disputing an insurers decision is incredibly stressful. Decades of experience in disputing insurers decisions, has lead to us here at Zaparas Lawyers being the experts you need to navigate the processes of conciliation, Medical Panels, and the court systems to ensure your rights are protected and you achieve the best possible outcome.
If you have been injured at work or have had a WorkCover claim rejected, feel free to contact us for a no fee, obligation free first appointment.
