What happens if a claim is not accepted or has ceased?
WorkCover Queensland carefully considers the facts presented when making decisions to either accept or reject an application for compensation or to stop payments for treatment or compensation.
Rejecting a claim
To make a decision on a claim, WorkCover must consider:
- whether the application has been lodged in time
- if the worker is a Queensland worker
- whether a work-related event caused the injury.
Based on the facts presented, we determine if we will accept or reject a claim. If the application is not accepted, one of our claims representatives will speak to the worker and explain the decision that has been made. A letter will be sent to the worker explaining the information considered and the reason why the application was not accepted. The letter will also outline review rights through the Workers' Compensation Regulator.
We encourage workers to talk to their claims representative after reading this letter if they have any questions. Workers can also ask to speak to a manager or lodge a complaint through WorkCover's internal process.
Ceasing a claim
We consider if the necessary and reasonable treatment has been provided and whether a worker is able to work due to the accepted work-related injury.
A claim may be ceased and payments stopped for different reasons. For example, if a worker has received all appropriate treatment for their work-related injury, however requires additional treatment for a pre-existing or non-work-related condition or injury, WorkCover Queensland will be unable to pay for the additional treatment. This will be determined on medical evidence.
What a worker can do
- talk to their health insurance provider about whether they can cover the costs of treatment
- talk to their superannuation fund or income protection insurer to see if they have sickness and accident coverage
- talk to their doctor about treatment options in the public system
- consider funding the treatment themselves
- if an injury was the result of a motor vehicle accident, a worker could contact their compulsory third party insurer
- if a worker is a victim of a violent crime, they can contact Victim Assist Queensland for support (including possible financial support).
Additional services may be available for psychological and psychiatric conditions
- a worker could talk to their doctor about access to public treatment options including the Mental Health Care Plan or contact could be made with a community mental health care service
- other useful service providers include:
- Lifeline 24 hour counselling: 13 11 14
- Salvo Careline 24 hour counselling: 1300 36 36 22
- Beyondblue Info Line: 1300 22 4636
- Sane Australia: 1800 18 SANE (7263).
If a worker is unable to work due to a non-work-related injury, workers are encouraged to:
- talk to their employer about accessing sick leave entitlements
- talk to their income protection insurer
- talk to their superannuation fund as they may have sickness and accident cover
- talk to Centrelink.
If a worker or employer has questions about a claim, they can contact WorkCover on 1300 362 128, or speak to the claims representative or customer advisor directly.
If an employer self-insures, the relevant claims department can be contacted.
- Last updated
- 14 June 2019