Rejected or ended claims

An insurer’s decision to reject an application for compensation or stop compensation payments is made after taking into account all the facts relating to a claim.

An insurer will look at:

• whether a claim was made in the right timeframe
• whether a worker is a Queensland worker
• whether an injury is work-related, including details of how, where and when it happened
• the reason for and duration of incapacity
• a worker’s capacity to return to work
• what the treatment needs are for a work-related injury.

A claim has been rejected. What now?

An insurer will speak to a worker and explain the reasons why the claim was rejected. They will also provide a worker with their reasons in writing.

If a worker or employer do not agree with the decision they can ask for it to be reviewed by the Workers Compensation Regulator.

If a worker or employer has concerns about the way a claim has been managed, these should be raised with their insurer in first instance.

A claim was approved but has now been closed. What now?

There are different reasons why an insurer might cease a claim and stop payments.

The reasons are generally (but not always) to do with whether a worker has received the necessary treatment for a work-related injury and whether they’re able to work.

An insurer will make this decision based on medical evidence.

If a worker or employer do not agree with the decision to close a claim they may be able to ask for it to be reviewed by the Workers Compensation Regulator, if the decision meets the requirements to be reviewed.

What if further treatment is needed that’s not covered?

If treatment is still required for a pre-existing or non-work-related condition or injury, a worker can:

• talk to their health insurance provider about covering costs
• talk to their superannuation fund to see if they have sickness and accident cover
• explore their options in the public health system with a GP
• talk to a third party insurer, if they were injured in a car accident
• if a condition is psychological or psychiatric, talk to their GP about a mental health plan or access other mental health support resources.

What if a worker is not able to work?

If a claim has ceased and a worker doesn’t think they can work, they can:

• speak to their doctor about what they may be able to do at work
• speak to their employer about any leave they can access
• discuss other duties with their employer so that they can get back to work if possible
• talk to their income protection insurer, if they have one, or see if their superannuation fund has sickness or accident cover
• talk to their insurer about programs that may be able to support them once their claim has ceased
• talk to Centrelink.