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Why did my Insurer accept this claim?

  • tcappola
  • Dec 4, 2023
  • 2 min read

Updated: May 24, 2023

As Consultants we are often asked why an Insurer has accepted a WorkCover claim.

Here are some summarized considerations that may explain the process:

  • All WorkCover Insurers are authorized Agents of WorkSafe/ WorkCover.

  • Your Insurer/Agent must follow strict legislative guidelines and be audited regularly to ensure compliance. Fines may apply to your Agent should they fail to meet guidelines and any breach places them at risk of losing their license as an authorized Agent of WorkSafe.

  • The legislation covers most employees for most injuries that occur on your watch and within your workplace. These injuries may include, however, are not limited to, the following:

  • Aggravation of a pre-existing condition.

  • Acceleration of a pre-existing condition.

  • New injuries that allegedly occurred in the workplace and that substantial proof to the contrary is not available.

  • An injury has occurred whereby employment has been a contributing factor.

  • A work-related mental injury.

  • Work-related death.

  • Exacerbation of a pre-existing injury.

An employee that meets the definition of a “Worker” may have an entitlement to many areas of compensation if they meet legislative criteria. Some include:

  • Payment of weekly benefits.

  • Payment of medical expenses.

  • Payment of a lump sum for permanent disability (separate and not impacting on weekly wages).

  • A Common Law payment

PREVENTION AND EARLY INTERVENTION


  • Choose your staff carefully matching skills to duties.

  • Carry out thorough reference checks.

  • Train your staff well

  • Eliminate/minimize risk

  • Manage each case proactively and seek advice as needed

MINIMIZING CLAIMS DURATION -CORPORATE SPECTRUM CLIENTS ADDED ADVANTAGE.

  • Corporate Spectrum Pty Ltd employs Consultants with between 15-30 years of WorkCover experience to assist you in minimizing the duration of your claims where possible.

  • Our Consultants have sound practical and commercial knowledge.

  • Please contact Trish Cappola on 0404 014821 should you require any assistance.

 
 
 

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Terms of Service - Corporate Spectrum does not absolve any organisation of the responsibility to comply with legislative requirements. Our guidance and partnership are not intended to provide or replace legal, medical, insurance or financial advice, nor does it or can it encompass end-to-end compliance services, audit against compliance, or absorb key roles. We provide additional advisory support and our advice is provided "without prejudice".

It is essential for organizations to appoint and thoroughly train internal qualified resources in each state and assume full responsibility for all policies, procedures, and compliance measures. Any advice provided is for the consideration of your experienced team. While our services may involve liaising with onsite return-to-work coordinators, WorkCover Managers, stakeholders, etc., the ultimate responsibility remains with your internal team and this is not in replacement of the steps required to be taken by your internal RTW Coordinator/s. Despite circumstances where there is a necessity to have multiple return-to-work coordinators, we do not offer such external services to absorb the role despite our assistance in some facets. Our agreed-upon hours are limited, and our structure operates via E-commerce. While we provide support for some related tasks and may assist your RTW Coordinators and claims resources the onus is on your internal team to understand and ensure all compliance boxes are checked in respect of each case. Our structure, limitations, and service scope necessitate that our clients adhere to legislative requirements at all times.

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