When to request your Insurer to investigate a claim

Supporting your injured worker to return to work as soon as possible is necessary to meet your legal obligations, is good for your worker and can keep the cost of your WorkCover Insurance Policy down.

Depending on the circumstances surrounding the lodgment of a WorkCover claim, there may be times when the legitimacy of a claim needs to be addressed to ensure you as the employer, are paying for an injury that is work related.

Below are some examples of when a claim should be held pending and investigated:

  • No evidence of an injury occurring in the workplace, no witnesses.

  • Worker is no longer in your employ and lodges a claim after the fact.

  • As a result of a reasonable and documented performance plan.

  • Claim is submitted after an extensive leave period or weekend where no incident was reported of witnessed the week prior.

  • Willful misconduct.

When surveillance may be useful

If you believe an injured worker is malingering then surveillance may be useful in determining the activities being undertaken by the worker.

This information can be helpful for Medical Examiners or even the workers GP when it comes to determining a true capacity for suitable duties.

Surveillance is also exceptionally useful should you have evidence that the worker is working elsewhere whilst receiving WorkCover benefits.

The more details you are able to provide to the Insurer with generally speaking the better the outcome!

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Disclaimer

Please note that Corporate Spectrum does not eliminate any organizations need to be responsible for meeting legislative requirements. Our advice is not intended as legal advice.

Organizations are required to accept final responsibility in respect of all policies, procedures and compliance. Onsite return to work coordinators and OH&S representatives are required by your business internally if appointing our services. This is  despite being able to have more than one rtw co-coordinator and legally being able to employ, in many instances, in this capacity externally. Our agreed hours are limited, our structure is via Ecommerce and whilst many tasks we perform are to support certain  areas overlapping with compliance issues, our structure and scope of services provides that our client base must ensure legislative requirements are adhered to at all times.