Despite significant improvements in safe workplace practices over recent decades, injuries do occur, whether they be physical or psychological and whether they be in conventional workplaces or the increasingly evident work-from-home environment.
In any event, in general terms, the injury must occur in the performance of workplace duties, or during required relaxation breaks, so an injury sustained while running to catch the bus isn’t covered, except in particular circumstances. The possible scenarios of workplace injury are many and varied with every case treated on its merit, however, whatever the bona fides of any claim, it is vital that proper procedures are followed if there is to be a successful outcome.
Possible outcomes include:
- Weekly payments
- Coverage of medical and potentially legal costs
- Rehabilitation costs
- Lump sum payments
- Claim rejection
Sometimes, perfectly legitimate claims are rejected purely through a lack of proper evidence and procedure, and that is a great pity.
Workplace injuries are not always clear-cut. A broken wrist or sprained ankle is clear enough, but there are times when ongoing physical or psychological demands can eventually result in injury, yet the actual starting point has become blurred, and no claim has been submitted as no one event seemed to be the cause. All such circumstances can nevertheless be extremely stressful, and the employee may well have enough painful distractions that their focus will be on dealing with daily events rather than proper claim procedures.
First things first
The vital first step is to seek medical treatment and advice. This is important for two reasons, the main one being that the employee’s welfare is the primary concern. The second reason is that the treating doctor should be made fully aware of the circumstances and work implications of the injury. They can then make a proper judgment in terms of:
- A treatment plan and likely recovery time
- The possibility that lighter duties may be performed
- The issuance of a NSW SIRA Certificate of Capacity form
The State Insurance Regulatory Authority (SIRA) has replaced Workcover as the government department responsible for overseeing workers’ compensation claims. SIRA hand the day-to-day insurance activities to the usual group of insurers: QBE, GIO, Allianz, etc. who are known as scheme agents.
Reporting and paperwork
By law, employers are required to have an injury reporting system in place. In any event, an injured employee should, preferably within 30 days:
- Advise their employer in writing of the injury, including dates, times, and circumstances
- Attach the SIRA Certificate of Capacity
- Attach a Workers’ Compensation claim form
Having received the claim, the employer is required to notify the insurer within 48 hours, and they, in turn, are legally required to begin weekly benefits payments within 7 days of the claim being made, provided of course that it is approved.
But what if?
The most common reasons for claim rejection are incomplete details, insufficient medical information, or insufficient evidence that the injury is work-related.
The SIRA has established the Independent Review Office (IRO, formerly WIRO) to assist injured workers with their claims.
It cannot be stressed enough that a claimant acts in utmost good faith – just as the insurers are required to do – and keep a written and accurate timeline of all events, from the time of injury onwards, including copies of forms, letters, and emails, and accounts of all discussions.
While claimants may deal with such things rarely, experienced workers’ compensation lawyers successfully negotiate the process every day. Sound professional advice is of paramount importance.