What to do if your Tasmanian worker’s compensation claim is disputed?
If you’re injured at work in Tasmania, you’re entitled to lodge a claim for worker's compensation. If your claim is accepted, you will be entitled to weekly payments, medical expenses and other benefits. But what happens if your WorkCover claim is disputed by your employer?
How long does your employer have to make a decision on your WorkCover claim?
After you submit a worker’s compensation claim for your workplace injury, your employer has 84 days (from the date you lodge your claim) to decide whether they will accept or dispute it.
While this decision is being determined, you are entitled to receive cover for reasonable medical expenses and weekly payments.
Further, although your claim has been disputed it is important to note that your claim has not been rejected. You should continue obtaining medical certificates and submitting them to your employer while you have an incapacity for work.
What happens if my employer disputes my claim?
If a decision is made by the employer to dispute your claim, they must:
- inform you in writing; and
- provide the reasons for disputing your claim; and
- make a referral to the Tasmanian Civil & Administrative Tribunal (TASCAT) in accordance with section 81A of the Workers Rehabilitation and Compensation Act 1988.
A referral to TASCAT under section 81A is essentially a means for the employer to inform TASCAT that they are disputing liability for your claim and to provide appropriate reasons for doing so together with relevant material to support their referral.
The types of material the employer may provide with their s 81A referral can include:
- medical reports;
- witness statements;
- surveillance/video/photographic evidence.
The employer must also provide you with copies of any evidence, prior to the TASCAT hearing.
What’s the process if my claim is referred to TASCAT?
Once the matter is referred to TASCAT, the tribunal must consider whether there are reasonable grounds for the employer to have disputed the claim. TASCAT will set a hearing date within 14 days of receiving the employer’s section 81A referral. You will be informed about this in writing.
Section 81A hearings are preliminary hearings and are therefore NOT determinative on whether the claim should be accepted or rejected. Instead, what is being decided is whether TASCAT is satisfied that there is a "reasonable basis” for the employer to dispute your claim.
Both you and the employer will have an opportunity to submit evidence (prior to the hearing), in support of your respective positions.
What might an employer consider when rejecting a claim?
Historically, the threshold for an employer to be successful in a section 81A hearing before TASCAT is very low as all that they need to do is show that there is a dispute in the case.
Here are some examples of material commonly used by an employer to advance their case to dispute your claim:
- Evidence that you were not at work on the day you were injured or that you were injured outside of the workplace;
- Medical evidence from an independent doctor that your ongoing injury is not work-related and is due to degenerative changes or a pre-existing condition;
- Evidence that your injury should not be covered because it arises from disciplinary action, counselling or administrative action.
If TASCAT accepts the employer’s decision to dispute your claim
If TASCAT decides there is a reasonable basis for the employer to dispute your claim, you will be notified of this decision in writing.
If you accept the Tribunal’s decision, your claim will not proceed.
If you do not agree with the Tribunal’s decision and you want to pursue your claim further, you will need to lodge another referral with TASCAT.
At this point, it is highly recommended you seek advice and assistance from your Union or a lawyer experienced in worker’s compensation claims in Tasmania.
If TASCAT rejects the employer’s decision to dispute your claim
if TASCAT decides that there is no reasonable basis for the employer to dispute your claim, your claim will be treated as though it had been accepted and you will continue to receive cover for reasonable medical expenses and weekly payments.
An employer can still dispute your claim and/or refuse to pay for certain medical expenses following the initial decision.
Should this be the case, it is highly recommended you seek legal advice.
Get help from a worker's compensation lawyer
If your worker’s compensation claim is accepted, your weekly payments, medical expenses and potentially some other benefits like domestic assistance, will commence.
If your injury is permanent, at some point when it has stabilised, you may also be eligible for a lump-sum payment for permanent impairment. It is recommended that you seek legal advice about your eligibility and options regarding a permanent impairment claim to ensure your entitlements are protected.
If your claim is disputed or rejected, or you have any other issues during the life of your WorkCover claim, our worker’s compensation team in Tasmania are highly experienced in helping injured workers get all the compensation they deserve.
Contacting Hall Payne Lawyers
You can contact us by phone or email to arrange your consultation; either face-to-face at one of our offices, by telephone or by videoconference consultation.
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This article relates to Australian law; either at a State or Federal level.
The information contained on this site is for general guidance only. No person should act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your particular circumstances. For further information, please do not hesitate to contact Hall Payne Lawyers.