3 Reasons Why Workers Compensation Claims get Rejected

There are thousands of workers compensation claims filed each year within Queensland. This means there is bound to be a sizeable number of rejections within that pile for any number of reasons. Understanding that you are not alone if you have recently received a rejection on your claim is a good start, but knowing why it may have happened in the first place is step two. WorkCover Queensland provides compensation insurance to businesses around the state. They make decisions based on a number of factors and the facts they have access to in front of them which is why it’s important to get advice where possible. Here are 3 reasons why workers compensation claims get rejected and what to do next if your claim has been rejected.

The claim was not lodged within the required timeframe

Even though you may feel overwhelmed and disheartened after experiencing an injury at work, once you have swiftly informed your employer after the incident, you will need to lodge your WorkCover claim within six months of the injury occurring. While it may seem like a tight turnaround of events, it’s also an optimal length of time to ensure you get all the facts correct from the beginning; the more detail you can provide WorkCover, the better equipped they’ll be to assess your claim. In an ideal world, submitting your claim within a few weeks will give you the best chance at getting the facts straight while the incident is fresh in your mind. There are exceptional circumstances where the timeframe may be waived such as absence from the state or a reasonable cause, but unless you have sought legal advice to be completely sure this is an option for your situation, the mandated timeframe is six months.

The injury wasn’t directly work-related and/or it took place outside work

Non-related work injuries mean anything that might occur in your personal life or when you’re ‘off the clock’. Even under flexible working arrangements, a policy is expected to be in place outlining the expectations of your at-home ‘workplace’ including working hours, requirements, and tasks. Examples of incidents that happen outside of this are similar to occurrences like slipping on your way to the grocery store, or spraining your wrist at the gym. Depending on the details of your situation, suffering an injury while on your way to a work meeting and even travelling between jobs for different employers could still mean you are eligible for compensation but again can be difficult to decipher if there are key details missing in your claim.

There was a pre-existing condition

You may be required to disclose any pre-existing conditions you suffer from to your potential employer to ensure you are fit to complete your daily activities. The beginning of your employment is the ideal time to let your employer know if you have any notable medical history that has the potential to hinder your work. While you are still well within your rights to lodge a worker’s compensation claim, there must be valid proof that your work was a ‘significant contributing factor’ that aggravated or exacerbated your pre-existing injury. Judgement is often made on the basis that your injury may be degenerative but you are still able to make an appeal if the rejection rests on this.

If you have recently been injured at work and have been through the claim process only to be met with rejection, let us help. You can also find a helpful guide on what type of rejection you are dealing with here. Find out more about appealing a rejected workers compensation claim and seek legal advice to ensure you are putting your best foot forward when you go through the appeal proceedings. With Gouldson Legal; we’re more than your WorkCover Claim Lawyer. We guide you through the journey and keep in touch every step of the way to give you peace of mind during a stressful and complex time.