Workplace injury compensation claims may seem easy to work through. After all, many people file them every year. But the claims process isn’t an easy one to work through.
Some claims run into issues along the way. The claims may get denied. In that case, you may need to consult with a compensation law firm in Sydney.
Workers’ compensation law firms can help you through the process of getting a workplace injury claim approved or overturned.
Here’s what you need to know about how denials get overturned, what you can do if you need help, and what to do if things get difficult.
How Do Insurance Claims Work?
When a person gets injured or develops an illness at work, they can make a claim for workers’ compensation benefits. Workers’ compensation covers the cost of the injured person’s medical treatment and lost wages.
Workers’ compensation claims go through an assessment by insurance experts. These experts consider the evidence the injured party provides and determine whether to approve the claim.
The vast majority of workers’ compensation claims in Australia get awarded compensation benefits. Still, there are always exceptions to the rule.
Why Do Compensation Claims Get Denied?
There are several reasons why an insurance company may deny your claim. Reasons for denial could be related to the insurance policy. These reasons might include:
- Certain policy exclusions regarding the specific circumstances of the injury or illness
- The policy got cancelled for some reason
- The claimant ignored certain conditions of the policy
- The claimant did not disclose all pertinent information to the insurer
Other reasons for denial might be related to the evidence provided by the claimant. For example, the insurer might deny the claim if:
- There is evidence that the injury did not occur during the course of employment
- The inability to work is not related to the injury
- The inability to work is the result of a previous injury
- The worker does not qualify as a worker according to the WorkSafe Act
- The worker’s employment didn’t substantially contribute to the injury
- The treatment the worker is seeking for the injury is not reasonable or necessary
Most often, insurers deny a workers’ compensation claim because the person has recovered from their injury. Their decisions are based on specific procedures dictated by the General Insurance Code of Practice.
With that being said, mistakes still happen. Insurers are expected to be honest and fair in their decision-making, but that is not always a guarantee.
What to Do if Your Claim Gets Denied
When an insurer denies your claim, they should send you a Section 74 Notice. This notice contains all of the relevant information about your claim. It also includes all of the medical evidence for your injury or illness.
Technically, an insurer is not allowed to deny your claim without sending this notice. Some insurers will inform an injured worker of their claim’s denial over the phone. This is a violation of workers’ compensation legislation.
If you receive a Section 74 Notice, don’t panic. You still have options. If you believe the decision to be made in error, your workers’ compensation lawyer can challenge the decision with the Workers’ Compensation Commission.
Benefits of Using a Law Firm to Represent You
Challenging a denied claim isn’t a straightforward process. It is in your best interest to have the legal expertise of a lawyer who knows how the system works.
In addition, going head to head with an insurance company is no small feat. You will benefit from having the support of someone who has professional expertise and the experience to navigate the process for you.
A lawyer will assess your claim themselves. They will find any weaknesses in your claim and help you strengthen them. Finally, they will find potential mistakes on the part of the insurer that may be helpful to your claim.
When researching Sydney law firms to handle your workers’ compensation claim, make sure you choose one with workers’ compensation expertise.
What You Need To Know About Compensation Law Firms in Sydney
Most Australian businesses are required to purchase workers’ compensation insurance for their employees. This is for the best considering the fact that an estimated 560,000 workers experience injury or illness at work each year.
The majority of compensation claims get awarded benefits. However, these claims don’t always get paid right away.
Australian workers’ compensation laws are based on the principle of no-fault. Therefore, a worker only needs to prove that their injury or disease is related to their work. A worker does not need to prove their employer was negligent.
Still, some compensation claims get denied. If this happens to you, it’s in your best interest to hire a Sydney workers’ compensation lawyer.
When hiring a law firm in Sydney, the most important thing is to find the right lawyer for your case. Look for a lawyer with legal experience specific to your situation. Only a workers’ comp lawyer will cut it.
Trust your instincts. If a lawyer doesn’t feel like a good fit for you, they probably aren’t. It’s also a good idea to read reviews and find out how many cases like yours the lawyer has worked on before.
Another important thing to find out about law firms in Sydney is how their fees work. Some Sydney law firms charge an hourly rate, while others operate on a fixed rate or a contingency fee.
Keys to Handling Your Compensation Claim Denial
A denied compensation claim may be rare, but it isn’t the end of the world. There are steps you can take to challenge the insurer’s decision. Compensation law firms can help.
The first thing to do is to hire a workers’ compensation lawyer with the experience and expertise to advise you and achieve the best possible outcome. Contact Barwick Boitano Lawyers to learn more.