What is the insurer’s role in my claim?

The insurer has a significant role in the Workers Compensation System.

When notified of an injury the insurer must:

  • Speak to the worker and the employer and consult with all relevant parties including the treating doctor to ensure the worker receives assistance to return to work
  • Provide the worker with all the information necessary regarding the claims process
  • Decide within 7 days whether to make Provision Liability payments or ‘reasonably excuse’ the claim
  • Decide to approve and pay for medical expenses
  • Decide whether the insurer or the employer will pay the worker the weekly benefits
  • Develop and maintain an injury management plan for the workers to return to work
  • Provide the worker with contact details of the WorkCover Assistance Service which is a body set up to assist workers to assist with the scheme agent or insurers
  • If a claim is declined the insurer must provide a written explanation outlining the reasons for denying the claim, including attaching all relevant reports and documents the insurer relied upon to decline the claim