Dealing with insurance companies in your workers compensation claim

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Robbo’s on Compo!

Maybe he is, but he would not always have been. Initial attempts to look after injured workers date back to British law in the late 1800s. Coverage then was not compulsory and required that the employer be at fault. Needless to say, when push came to shove, workers were in practice, on their own.

After the Federation in Australia, work began on no-fault coverage, and by 1926 NSW led the way with compulsory compensation coverage that did not require workers to prove employer fault. Even so, had Robbo been Rebecca, she would have been out of luck. The first few decades of compensation were referred to as workmen’s compensation until challenges in the 1970s saw coverage rightly extended to all workers, and workers’ compensation was born.

The laws have developed steadily over the last 100 years, thankfully matched in more recent times by even greater emphasis on workplace safety – far better to avoid the injury, whether physical or mental, in the first place – a stitch in time …

 Who, when, where?

All employers in NSW who expect to pay annual wages over $7500 to workers, or who have an apprentice, must have:

  • A workers insurance policy
  • An injury reporting system
  • An effective return to work program

 In this context, a worker is someone who receives wages or commission, irrespective of the number of hours worked and includes full-time, part-time, casual or contract workers.

 Such coverage insures employers against the cost of supporting workers in the event of workplace injury, illness, or disease, and includes:

  • Weekly benefits
  • Medical and hospital expenses
  • Rehabilitation
  • Lump-sum payments – in certain circumstances

 Policies can be provided by the Government for their employees in Government agencies and defence, but otherwise are administered by the State Insurance Regulatory Authority (SIRA), formerly Workcover. SIRA delegates the day-to-day policy handling to scheme agents, essentially the usual array of insurance companies – QBE, GIO, Allianz etc.

Such companies are bound by SIRA regulations and therefore by the Insurance Contracts Act 1984. One clause that particularly stands out requires both parties to act in utmost good faith.

Coverage applies to workers while performing duties at work. This does not include travelling to or from work unless they are required to travel via a third-place for work purposes – perhaps to deliver or collect goods.

Should a claim be necessary, then a worker should, within 30 days of becoming aware of the injury:

  • Report the injury to the employer
  • Visit a doctor (for treatment), and also obtain a Certificate of Capacity
  • Request a workers’ compensation claim form from the employer
  • Complete and submit the claim form

It is imperative that workers making claims:

  • Report truthfully and accurately
  • Keep copies of all documentation, and record an accurate timeline
  • Obtain professional advice

Despite the glossy brochure promises, insurance companies are not known for flinging funds around willy-nilly, and will invariably play hard ball in order to minimise their outgoings.

If a claimant expects an insurance company to act in utmost good faith, then they should make sure that they have done likewise, in order to present a squeaky-clean case. Embellishing or understating the truth is not conducive to a satisfactory outcome.

Workers making workers’ compensation claims are not experienced in dealing with potentially hard-line insurance company methods. Lawyers who deal daily with work-injury law are.

If you are suffering from a work-related injury, you already have enough on your plate. Workers Compensation – share the load with Owen Hodge Lawyers. We are here to help. Contact us today on 1800 770 780 or via email at ohl@owenhodge.com.au.

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