We have put together information to keep injured or ill persons informed of what to expect.
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All employers play a crucial role in the prevention and management of workplace injuries.
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Information for Psychologists, Occupational Therapists, Nurses, Exercise Physiologists and Doctors.
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Other key stakeholders are also encouraged to provide Information and comments about issues of relevance .
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Insurer/ Agent Issues


It was mentioned previously that the Insurers / Agents are the managers, gate keep and bean counters of the NSW Workers Compensation system. Since the new 2012 legislation was passed they have been given increased powers and responsibility for managing the claims and in ensuring costs are controlled.

 

For injured workers, nominated treating doctors, treatment providers and occupational rehabilitation providers the relationship they have with the claims officer managing a particular injured workers claim can and does make an enormous difference to how quickly decisions are made, referrals and treatments approved and payments made. Although there is legislation in place and guidelines set by WorkCover about what can and cannot be done and when, the level of efficiency, attitude and professionalism of Agent staff varies greatly between and within Agencies in NSW.

 

Hopefully the Agent is managing your claim well to reduce the risk of the injury continuing after 6 months. 

 

At the 4-6 month stage of a claim the most typical challenges from agents are in the following areas:

I. Full liability continuing to be accepted

II. Provisional Liability

III. Reasonable excuse

IV. Declined claim

 

Potential problems with the status are overviewed below.

 

Full liability continuing to be Accepted - With fully accepted liability a claim is accepted in full within the guidelines of legislation. Wages should be payed, travel and medically related expenses refunded and “reasonable and necessary” treatments provided. Problems most frequently reported by injured workers relate to delays or denial of treatment or specialist referrals and late or non payment of wages and expenses. Calls to the Agent and then WorkCover is the best way to address these issues

 

Provisional Liability -You will have a decison by now. Hopefully the claim was accepted if genuine. If liability has been declined you may be apprealing the decision and will need to self fund treatment or access treatment through Medicare or Private Health Insurance.

 

Reasonable Excuse - You will have a decision buy now.  If liability is accepted costs will be back paid. Centrelink benefits will have to be back paid if the claim is accepted. Injured Workers are advised to contact a lawyer at this stage for advice if the claim was declined; however, no action can be taken in terms of an appeal until a decision has been reached. If the Agent takes longer than those of the guidelines, a call to Workcover may help in a decision being made, with the time frame guidelines.

 

Declined Claim - A decision may have been made by the Agent in writing with reasons according the Workers Compensation Act outlining why the claim is declined. You will  need to consult a lawyer whether and how to appeal the decision.

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