Anyone who has ever been hurt at work knows that the process of Workers’ Compensation can be complicated. Your doctor might tell you one thing and the company doctor might tell you another. It’s hard to know what’s going on if you get conflicting signals. Here’s how Workers’ Compensation is supposed to work.
When are You Eligible to Make a Claim?
According to the law, if you are defined as a worker and sustain an injury while working, you are eligible to file a claim for workers’ compensation. Whether you are classified as full time or part time, seasonal or casual, commission or piece worker, you are defined as a worker. If you are a contractor, a subcontractor, a working director or even a member of the employer’s family who is living in the same house, you can still be defined as a worker.
If your injury requires medical treatment or results in time off work, you can file a claim. This includes a personal injury while following the instructions of the employer or in the course of working for the employer. It also includes any disabling disease that is contracted as a result of employment and can even include a case where employment aggravates a pre-existing disease.
How Do You Make a Claim?
When injured, your first step is to seek first aid. Then, report the injury or incident to your employer. Next, you see a doctor of your choosing; ask your doctor for a First Medical Certificate. Then, you will have to complete the Workers’ Compensation Claim Form.
If you are having a hard time understanding or completing the form, WorkCover WA recommends that you ask your employer to help you. If you are still having trouble, they recommend contacting their Advice and Assistance Unit or Services. We recommend a lawyer for reasons we will get to later.
Then, after making copies for your records, forward the claim form and First Medical Certificate to your employer.
What Happens Next?
The law gives your employer five business days, which works out to one calendar week, to send both the Claim Form and the Certificate to their insurer. Their insurer gets another 14 days to decide whether or not to accept or reject your claim and get back to you.
When your claim is accepted, the system works as it should. Your employer is required to immediately start making weekly compensation payments. For however long your period of injury lasts, you will get paid on payday, just as if you are working.
But What if Your Claim is Disputed, Which is Another Way of Saying It is Denied?
This is where the system can often let an injured worker down. You know you are injured, you can’t work, but you are being told that you will get no money until you get back to work. The insurer is required to tell you their reasons for denying your claim. The next step is to ask the insurer to reconsider their decision.
If that doesn’t work, you are allowed to contact the Conciliation and Arbitration Services for what is called an “independent review.” This has to be done ASAP.
Occasionally, a case will be put “on hold” and more information will be requested. This gives the insurer another ten days to consider your claim. If you still haven’t gotten a decision, the claim is considered to be “in dispute” and you can file a claim to the Conciliation and Arbitration Services.
When the Employer’s Doctor “Reviews” Your Claim
Your employer can send you to their doctor as soon as you lodge your claim and every two weeks for “review” if they want to. They have to do this during reasonable hours and you are not allowed to be sent to more than three doctors in the same specialty of medicine.
Returning to Work
When you have recovered and your doctor says you are fully ready to return to work, you will return to your old position at work. If you are, as the policy says, “reluctant” to return to your former position at work, or feel that you are only partially recovered, you can talk to your employer about a “return to work” program.
How to Help Make Workers’ Compensation Work as It’s Supposed to
During the entire process, there is nobody to look after your interests. That is why we recommend legal representation throughout the process. You need someone who knows the law on your side, making sure that you receive full compensation.
If you are hurt on the job, make sure you get the full benefits to which you are entitled. Call Bradford Legal: 1300 738 303.
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