Injured People

Challenging a WorkCover Decision: When Do I Need a Lawyer?

When dealing with your workers compensation claim there are a number of situations where it can be important to have a lawyer, including disputes, writes TGB's Toni Emanuele.

Update-  Due to the enactment of the Return to Work Act on 1 July 2015 the law in this area has now changed, for more information click here

 

When dealing with your workers compensation claim there are a number of situations where it can be important to have a lawyer, including disputes, writes TGB’s Toni Emanuele.

WorkCover has stopped my weekly payments.

Workers are often left surprised and concerned when WorkCover decides to stop providing weekly payments. A common reason for doing so is because the corporation has decided that you have regained the capacity for work. This can happen at any time whilst you are on WorkCover but is common when you have been in receipt of weekly payments for a period in excess of 130 weeks.

If a decision is made to stop your weekly payments it can be very stressful. It’s difficult to know what your rights are and how you can challenge this decision. A lawyer can assist you by considering what information WorkCover has relied on and looking at the decision to see if it’s lawful. A Notice of Dispute can then be lodged at the Workers Compensation Tribunal. Legal representation will allow you to effectively challenge the decision if necessary. Having a lawyer will enable you to recover some or the majority of your legal costs from WorkCover.

Lump sum payment entitlement.

If you have suffered a physical injury you may have an entitlement to a lump sum payment. It is a lump sum for whole person impairment. You may need legal assistance when you have been assessed and you have received a decision from WorkCover stating that you have reached a level of permanent impairment.  If you’re not satisfied with the assessment a workers compensation lawyer can assist you. A second opinion can also be organised or a challenge can be made if you have been prevented from receiving the proper entitlements.

WorkCover won’t pay for the course I want to do.

You may have been talking to your case manager or rehabilitation consultant about your future. You have discussed your work experience, interests and work goals. You have provided information to them about a course or training program you’re interested in, and you feel it will assist with your re-training. If WorkCover is unwilling to pay for your preferred course then you should seek legal advice.  A workers compensation lawyer can assist you to secure funding for the course by challenging the decision made by WorkCover.

WorkCover hasn’t reimbursed my medical expenses.

When your claim is accepted you are entitled to reasonable medical treatment costs. This includes, hospital expenses, medication, periodic treatments such as physiotherapy, and travel to and from medical appointments. These expenses often need to be incurred first before they can be reimbursed. What happens though when you submit these accounts and you haven’t been paid? This is a common problem faced by injured workers. A workers compensation lawyer can assist you by asking WorkCover to make a formal decision in relation to the expenses and if necessary lodge a Notice of Dispute on your behalf in the Workers Compensation Tribunal.

Do I stay on WorkCover if I resign? 

Returning to the same workplace where you initially sustained the injury can be stressful for a number of different reasons. Resignation is often an option that is considered by WorkCover recipients. It is important to understand that your employer has an obligation to provide you with suitable duties within your restrictions pursuant to Section 58B of the Workers Compensation and Rehabilitation Act. If you decide to resign, your weekly payments of income maintenance will stop. You will be seen to have breached your obligations under the Act. This if referred to as “breach of mutuality”. You have an obligation to your employer to make yourself ready, willing and able to perform suitable duties. Further, if you commit an act that is considered serious and wilful misconduct the employer can let you go and your payments will stop.

Conclusion.

The above briefly touches on only some of many examples where workers seek the advice of experienced workers compensation lawyers in South Australia. It is important to note that the outcome of each issue will be depend on the individual circumstances of the worker.

If you need advice relating to your workers compensation issue, I can help. Contact me to arrange a free initial interview or register online here.