ARTICLE
19 January 2025

Rejected workers compensation claims in Queensland

HP
Hall Payne Lawyers

Contributor

Home to some of Australia's top-ranked employment lawyers, Hall Payne is recognised as a leading employment law firms by the prestigious Doyle's Guide. We aim to resolve your employment dispute quickly, fairly and discreetly. Our cost-effective legal advice spans all areas of employment law.
Many thousands of worker's compensation claims are lodged in Queensland every year.
Australia Employment and HR

Rejected workers compensation claims in Queensland

Many thousands of worker's compensation claims are lodged in Queensland every year. Although many applications are accepted and benefits are paid, some claims are denied. While this can cause injured workers a significant amount of stress, it's important to understand that a rejected workers' compensation claim is not the end of the road. Under the Queensland statutory workers' compensation scheme, there are options to have the decision to reject your claim reviewed.

Reasons worker's compensation claims are rejected

Under the Workers' Compensation and Rehabilitation Act 2003 ("the Act"), an insurer can deny a worker's compensation claim for multiple reasons, including but not limited to the following.

The claim for compensation was lodged out of time

Generally, an injured worker has 6 months from the date of injury to lodge a claim with a workers' compensation insurer. A failure to meet this time limit may result in the loss of a person's entitlement to workers' compensation. However, there are many exceptions, so it is important to seek legal advice if the insurer has rejected your claim on this basis.

The person's employment was not a significant factor to the injury

To be eligible for benefits under a workers' compensation scheme, the injury must be related to a person's work or have occurred during the course of employment. If the insurer does not believe the injury is work-related, for example, if the employer disputes the details of the incident, it could result in the rejection of an injured person's application for compensation.

There is insufficient evidence to substantiate the claim

WorkCover Queensland, the workers' compensation insurer established under the Act, generally has 20 business days to make a decision on your application. However, they may require more time to undertake further investigations or to obtain further information to assist in making a decision. If the insurer determines there is not enough evidence, such as medical reports or Workplace Health and Safety records, to determine the injury was work-related, they may refuse to accept a claim for compensation.

The injured person is not considered a "worker" under the Act

'Worker' is defined in the Act to mean an individual who

"works under a contract; and in relation to the work, is an employee for the purposes of assessment for PAYG withholding".

If, after their investigations, the workers' compensation insurer does not determine an injured person a 'worker' under the Act, their application for a claim will most likely be rejected.

If the worker's psychological injury was caused by "reasonable management action"

In the case of psychological injuries (for example, bullying or harassment), an insurer may reject the application for compensation if the injury was due to "reasonable management action". You can learn more about this in our previous blog, "Am I being bullied or is it reasonable management action?"

Whether an insurer accepts or rejects your claim, they are obligated under the Act to provide you with written reasons for their decision. If the notice of a rejected claim for compensation does not include the reasons the application was denied, the injured worker has 20 days to request this information. If you do not agree with the insurers' reasons for denying your application, one of our experienced workers' compensation lawyers can provide advice and guide you through your next steps.

Injured worker's timeframe to request a review

If a worker's compensation claim is rejected and the injured worker wishes to have that decision reviewed, they have three (3) months from the day of receipt of the insurer's written decision to request that review.

It is crucial that claimants begin the review process without delay, as they will require time to collate the relevant and supporting information and evidence.

We do not recommend that you pursue a review of a worker's compensation decision without advice and assistance from an experienced lawyer. Reviews are complex, and it is imperative that thorough and accurate information is submitted in a timely manner when requesting a review.

How is a worker's compensation decision reviewed in Queensland?

If you've received an adverse decision about your worker's compensation claim, including a rejected claim, an application for review must be lodged with the Worker's Compensation Regulator ("WCR"). The WCR is an independent authority and separate to WorkCover and other workers' compensation insurers.

Review requests must be lodged, either online, by post or by email, using the Claim Review Form 542.3. In addition to completing the form, written submissions stating your grounds for review and supporting documentation must be submitted as evidence. Supporting documents may include, for example, witness statements and further medical evidence.

The WCR has 25 business days to decide on your request for review. Should the WCR require an extension of time, this is to be communicated to you in writing, including reasons for the possible delay. The reasons are to be reasonable and not cause unnecessary delay to the decision-making process.

You are also entitled to a "Right of Appearance". This means you can meet with the Review Officer in person or make representations over the phone or by another method. This process provides an opportunity to raise any matters from your written submissions that you intend to highlight and bring to the forefront and to the attention of the Review Officer.

Reviewing a rejected application can often be a complicated and stressful process, so it is important to seek legal advice to help navigate through these difficult times.

Decisions the Worker's Compensation Regulator can make

There are three primary outcomes the WCR can make.

  1. WCR can determine that the original decision of WorkCover be dismissed and your worker's compensation claim proceed.
  2. WCR can uphold the original decision of WorkCover, meaning your claim is denied.
  3. WCR can make a variation to the original decision of WorkCover.

Can I appeal the WCR's determination to uphold WorkCover's original decision?

If the WCR confirms the insurer's decision to reject your application, you have a further appeal option.

You can lodge an application with the Queensland Industrial Relations Commission ("the QIRC"). An appeal is to be lodged within 20 business of receiving the WCR decision.

An appeal to the QIRC is complex and costly. It is vital that you seek legal assistance if you choose to appeal a decision of the WCR.

Get help from a worker's compensation lawyer

Although a rejected worker's compensation claim may prove to be challenging and not without its frustrations, it is important not to lose hope! With avenues available to have a decision reviewed or, ultimately, appealed in the QIRC, there are opportunities to protect your worker's compensation rights and entitlements.

It is important to take proactive steps to protect these rights, including seeking legal advice for guidance and general advice early. Speaking with a practitioner in our excellent team of personal compensation lawyers gives you the best chance to receive the compensation you deserve and are entitled to.

Further reading: Worker's Compensation Claims Queensland

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

Mondaq uses cookies on this website. By using our website you agree to our use of cookies as set out in our Privacy Policy.

Learn More