What happens if my workers compensation claim is declined?

If your workers compensation claim is declined, your Lawyer might be able to challenge it.

If you have any aspect of your claim for workers compensation declined by a S.74 Notice your lawyer will make an Application to the Workers Compensation Commission (WCC) to appoint an independent Arbitrator to hear and determine the issues in dispute.

What is the process?

1. Your lawyer files an Application for Dispute resolution with the WCC which includes all evidence to be relied upon.

2. The Insurer or its lawyer must file a Reply with their evidence within 28 days.

3. The matter is reviewed by the WCC and a telephone conference is appointed usually 28 days later.

4. We are notified by the WCC of the date and time of the telephone conference.

5. We will notify you of the details of the telephone conference which you must attend in person at our office or via the telephone.

6. At the telephone conference the Arbitrator will discuss the matter and the issues in dispute. The Arbitrator will see if the matter can be resolved by agreement. If not the Arbitrator will make orders for further preparation of the claim and list the matter for a face to face Conciliation/Arbitration Conference. Your lawyer will do the majority of the talking at the telephone conference.

7. Your lawyer will then confirm in writing the date and time of the Conciliation/Arbitration Conference which is usually 28 days following the telephone conference but must suit everyone’s availability to attend.

8. If further preparation is necessary your lawyer will contact you for further information.

9. The Conciliation/Arbitration Conference has two phases:

  • The Conciliation phase is where the Arbitrator will discuss the issues and see if the parties can reach agreement, if no agreement can be reached the matter proceeds to;
  • The Arbitration phase is where sometimes questions are asked to clear up any unknown matters

10. The Arbitrator then makes a written decision within 21 days.

11. The Arbitrators decision is final and binding on both you and the insurer unless the Arbitrator has made an error of law.

12. The outcome is confirmed by the WCC within 28 days later.

13. The insurer will then pay the compensation awarded to you. If any amount is payable as a lump sum this is usually paid by way of a cheque in your name sent to us about 6 – 8 weeks later.

If you would like further information, check out our Workers Compensation page or contact us to see how we can help.

About Matthew Garling

Matthew Garling, Founder of Garling & Co is a NSW Law Society Accredited Specialist in Personal Injury Law. He specialises in compensation law and has acted on behalf of thousands of injured people in work accidents, motor vehicle accidents and negligence cases over the last 20 years.

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