Deciding whether you intend to pursue a claim for benefits or common law lump sum benefits is the first step in the claims process. This determines which application forms and steps needed for getting the most compensation as quickly as possible
Claiming Statutory Compensation
In the case of statutory insurance, there is a relatively simple form which is available from WorkCover’s website that needs to be filled out as soon as possible after the injury is sustained or comes to your attention. Remember that some injuries can occur over time, such as repetitive strain injuries, without a specific incident. Once the form is filled and submitted to WorkCover, they will generally accept the claim and commence paying statutory benefits immediately. In the event that WorkCover rejects the form or ceases the payment of statutory benefits, you will need to seek urgent legal advice to understand what rights of review you have in respect of WorkCover’s decision to reject or cease paying compensation.
Claiming A Lump Sum Compensation
The process of claiming lump sum compensation commences upon completion of a Notice of Claim via the approved form. The Notice must be submitted to WorkCover within three years of the date of injury being suffered. Only in limited circumstances, will this time period vary.
Once the Notice of Claim is submitted, WorkCover will typically appoint one of its panel lawyers. The panel lawyers will investigate the circumstances described in the Notice of Claim.
Within six months of receipt of the Notice of Claim, WorkCover will provide a formal response to the worker’s Lawyer. This response will advise whether WorkCover accepts or denies liability for the claim or accepts liability in part.
Once WorkCover’s response has been received, the injured person will undertake one or more independent medical examinations. A qualified medical practitioner will conduct these to report on the nature of the injuries. In conjunction with obtaining independent medical evidence, our compensation lawyers help you to collate all information relevant to the claim such as:
- Medical records;
- Financial documentation;
- Out of pocket expenses; and
- Statements and advice from colleagues, witnesses and firm members.
Generally, statements and advice cover the circumstances of the accident, the nature and extent of the injuries that our client has suffered. They can also include the impacts that the injuries have had on our client’s day to day life.
After obtaining all medical evidence and relevant information, a compulsory conference is usually held. This is an opportunity to present your case to WorkCover’s lawyers and negotiate a settlement.
If negotiations are successful (our success rate is over 85%), an appropriate amount of compensation will be agreed, and you will enter into a Deed of Settlement with WorkCover. Compensation is then generally paid within 30 days.
On the rare occasion that a claim is not settled at the compulsory conference, the next step is to commence legal proceedings in the appropriate Court and engage in mediation.
Mediation is similar to a compulsory conference in that it is a formal meeting between WorkCover’s Lawyers and your team. They generally include a Barrister retained on your behalf. During mediation you will seek to further negotiate an appropriate payment to compensate you for injuries that you have suffered.
Compulsory conferences and mediation differ because an independent senior Barrister, usually a Queen’s Counsel, oversees mediation. The Barrister is engaged by both WorkCover and you to act independently. Their goal is to seek to broker a negotiated settlement of your claim.
As of 30 June 2017, all our client’s claims have been resolved either through mediation or before going to trial. If a claim doesn’t settle at a conference or mediation, it will go to trial before a Judge. The Judge will ultimately determine whether WorkCover is liable to compensate you and, if so, how much compensation you are entitled to.