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Can You Still Claim Compensation If WorkCover Have Rejected Your Claim?

if workcover reject claim

One very common question that injured workers ask is, “in the event that WorkCover rejects their claim, are they still entitled to claim compensation?”  In this podcast, Accredited Sydney Personal Injury Law Specialist, Mark Nelson answers the question.



Dan: For people who have suffered an injury at work in New South Wales, one of the preliminary steps in seeking compensation is to make a claim to work cover. But it so happens that a person’s claim may be rejected by them. So what do you do? Well, today I’m with Mark Nelson, an accredited personal law specialist and partner from Beilby Poulden Costello. Mark, let’s track through the process. So if a worker is injured, what has to happen next in terms of seeking compensation?

Mark: The first step that an injured worker has to take is to report the injury to a supervisor immediately at work. Many of the cases fall into difficulty at a later stage because a worker has either overlooked reporting the injury to work or has been effectively talked out of making an official complaint on the basis that it’s better for the employer that that doesn’t happen, and many workers find to their detriment down the track that their injuries have in fact become far more serious over time than was initially envisaged.

Dan: So Mark, for that injured worker who has lodged a claim, but it has subsequently been rejected, is it all over for them?

Mark: Absolutely not. Claims are rejected by insurers who act as agents on behalf of iCare, previously called Work Cover, for a variety of reasons, generally, the insurers take issue on three major areas. Firstly, that they argue that the person was not a worker for the purposes of the Worker’s Compensation Act. In the alternative, they will argue that the worker is not injured and as an alternative, they will argue that if the worker was in fact a worker for the purposes of the act, and was in fact injured, the injury was not due to anything that happened at work. When those denials occur and they’re very commonplace, lawyers can get involved to get permission from iCare to fund a case and run a case in the workers’ compensation commission to get people the compensation they deserve.

Dan: So, Mark, is there things that you need as a personal injury law specialist to get underway with assisting the person who is in this predicament?

Mark: There are. We need to have an initial meeting with the client. We can, of course, take instructions by telephone, but an initial meeting is preferred if possible. We need to prepare a very brief outline of what has occurred and attach any documentation that exists at that very early stage. WIRO, the funding agency for iCare, understand that at a very early stage, some of the documents won’t be able to be obtained, such as a full suite of medical records, and part of the funding that we seek, utilizing a very brief statement from an injured worker, is to seek an extension of funding to obtain the balance of the documents that we need in order to get to the workers’ compensation commission.

Dan: Mark, what’s the percentage of matters that perhaps are rejected at first blush but later proved to be successful?

Mark: Certainly, if the cases that we pursue, very high percentage are successful. Part of the reason for that is that we want to be very direct with clients and transparent about people’s prospects of success from the initial meeting. But the legislation is framed in a way that the vast majority of injured workers are compensated for the injuries that they suffer. The issues that are raised on a preliminary notice look very frightening to people when they receive a notice telling them that the agent has made a decision to deny liability. But the devil is always in the detail, and once we obtain detailed instructions from our clients that enable us to get evidence to meet the allegations raised by the insurer or the insurer agent, our clients can quickly see that with the workers’ compensation commission operating fairly as it does, that their case is likely to be successful. The statistics are always in the high 90% range for most of the firms out there, you see all sorts of claims being made. We simply take the step of making sure that our clients’ cases are vetted by specialists in the field, accredited specialists and partners of this firm, and that once we give an indication to our clients that they’re very likely to succeed, then that’s the case and they’re happy to instruct us to proceed on that basis.

Dan: And Mark, do you do this work on a no-win, no-fee basis?

Mark: We do. In fact, all of the lawyers in New South Wales are bound to act on a no-win, no-fee basis. Essentially, it’s illegal for lawyers in New South Wales to charge a client for any work related to investigating or acting in a claim for workers’ compensation benefits under the Workers’ Compensation Act.

Dan: Mark, thanks for joining me.

Thank you for listening. If you have any questions, please call BPC Personal injury lawyers on 02 8280 6900.