If you suffer a workplace injury it is essential you complete and lodge a workers compensation claim form with your employer, no matter how minor the injury may seem at the time. Before lodging your claim form however, you must first report your injury to your employer.
How do I report my injury?
The New South Wales workers compensation legislation requires workplace injuries to be reported as soon as possible after the injury and before voluntary resignation from employment. A workplace injury can be reported verbally, by completing an injury notification form or by making an entry in the injury register book held by your employer. The report of injury must contain your name and address, the date on which your injury occurred and the nature and cause of your injury.
Failure to notify your employer of your injury will result in you being unable to bring a claim for compensation benefits
How do I lodge my workers compensation claim form?
Following any injury, your employer must provide you with details of their workers compensation insurer and provide a compensation claim form when a request is made. This form should be completed by you and lodged with your employer.
If medical treatment is required for your injury, you have the right to consult your own doctor. Whilst some employers may insist you consult their “company doctor”, you are under no obligation to do this. You should have your doctor complete a Workcover medical certificate, even if you initially do not require time away from work. This certificate should be submitted to your employer along with your claim form.
Is there a time limit for making a claim for compensation?
Yes. A claim for workers compensation should be made within six months of your injury however, in certain circumstances this can be extended to three years.
What are my employer’s obligations?
Your employer must notify its workers compensation insurer with 48 hours of your injury if workers compensation is payable or may be payable.
Within seven days of receiving your claim form, your employer must complete their relevant sections on the form and forward it to their insurer. It must also forward within seven days of receipt any documents you provide in relation to your claim such as workcover medical certificates or accounts and receipts for medical expenses incurred.
If, following your injury you are unable to perform your normal work but are fit to perform selected or suitable duties, your employer is obligated to provide you with those duties if they are available.
During the first six months of your injury or incapacity your employer cannot terminate your employment because of your injury or inability to perform your pre-injury duties. If this occurs, your employer will be guilty of an offence under the workers compensation legislation and you will be entitled to apply for reinstatement of your employment.
What are the insurer’s obligations?
Upon receipt of initial notification of your injury, the insurer must within seven days:
• Provide you and your employer with a claim notification number
• Make contact with you and your employer and also your treating doctor
• Commence injury management if you are likely to be incapacitated for work for a period of more that seven continuous days.
• Decide whether to approve provisional liability payments in respect of weekly compensation benefits and medical expenses and if approved, commence payments.
What are provisional liability payments?
Provisional liability payments are payments made by the workers compensation insurer and consist of weekly payment benefits and medical expenses. They are designed to provide income support for you whilst investigating liability for your injury.
Under provisional liability weekly compensation benefits can be made for up to a period of twelve weeks from the first date you are incapacitated for work. In addition, reasonable and necessary medical expenses up to an amount of $7500 are also payable.
If the insurer pays provisional liability benefits and later rejects your claim, the insurer cannot seek reimbursement from you for payments made unless fraud is involved.
Can the insurer refuse to make provisional liability payments?
In certain circumstances, yes. The workers compensation insurer does not have to commence provisional liability payments if it has a “reasonable excuse”. The insurer will have a “reasonable excuse” if:
• There is insufficient medical information to establish that you have sustained an injury or that your injury is related to your employment.
• It is unlikely that you would be classified as a “worker” within the meaning of the workers compensation legislation.
• The insurer has been unable to contact you repeatedly – either by telephone or email and at least once in writing.
• You refuse to allow the insurer access to information, for example you do not consent to the release or collection of personal or health information about your injury.
• Your employer provides to the insurer acceptable evidence that you did not sustain an injury or that your employment is not connected with the injury.
• You fail to notify your employer of your injury within two months of the injury occurring.
• Your injury is not a significant injury (ie you are likely to be incapacitated for work for less than seven days).
If provisional liability payments are not commenced on the basis of reasonable excuse, the insurer must inform you in writing within 7 days of receiving your initial notification of injury. If you have not completed a workers’ compensation claim form and the insurer requests you complete and lodge such form, the insurer has 21 days to determine overall liability for your claim from the date you lodge your claim form.
Other compensation benefits which may be payable are travelling expenses, lump sum payment for permanent injury and negligence claims if you sustain serious injury as a result of the negligent actions of your employer.
How can we help?
Taylor & Scott are experts in all areas of workers compensation law. We have helped tens of thousands of injured people over the last 100 years. Call 1800 600 664 to find out how we can assist you in securing the compensation you deserve.
Remember at Taylor & Scott, we care for you.