WHY DID MY INSURER ACCEPT THIS CLAIM?

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

Here are some facts that may explain the process:

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

  • Your Insurer/Agent must follow strict legislative guidelines and are 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 authorised Agent of WorkSafe.

  • The legislation covers most employees for most injuries that occur on your watch and within your work place. 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 occur in the work place and that substantial proof to the contrary not available.

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

  • A work related psychological condition.

  • 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 settling the case.

PREVENTION

What can I do as an employer to prevent claims?

  • Choose your staff carefully matching skills to duties.

  • Carry out thorough reference checks.

  • Request new employees complete a declaration which requests that they list any ailment that may prevent them from doing their job safely. You have a duty of care to ensure each employee is not placed at risk.

MINIMISING CLAIMS DURATION

  • If you are registered for Corporate Spectrum’s case management services it is very important to get a copy of the incident report through to our office in order for our early intervention to commence.

  • If the first thing you receive is a claim form, fill in your employer claim form, attach all cert’s and invoices to the forms and send a copy to your Insurer and a copy to our office.

  • We will make contact with all relevant parties in an attempt to minimise the duration of this claim.

  • It is also recommended where possible to keep an amicable relationship with your employee.

  • Corporate Spectrum Ptd Ltd will work with you to look at all avenues in accordance with legislation in order to address any issues of entitlement.

  • Corporate Spectrum will assist you through the return to work process.

  • Where possible our aim is to resolve your claims.

CORPORATE SPECTRUM CLIENTS ADDED ADVANTAGE

  • Corporate Spectrum Pty Ltd employs Consultants with between 12-25 years WorkCover experience to assist you in minimising the duration of your claims where possible.

  • Corporate Spectrum Pty Ltd has a Consultancy team that case conference every claim. This team collectively has over 60 years of knowledge in this field and are dedicated to assisting employers in the management of work related cases.

  • Our Consultants have sound legislative, practical and commercial knowledge.

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

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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.