Are there fraudulent workers compensation claims?

Examples of the types of matters investigated by workers compensation authorities are:

• An injured worker on weekly benefits fails to notify the insurer or employer of commencement of other employment.
• An employer fails to pass on workers compensation benefits to an injured worker.
• An employer fails to pay sufficient premiums.
• A medical practitioner invoices for a consultation that did not take place or overservices a claim with unnecessary treatment.
• An injured worker submits an altered medical certificate.
• Injury didn't occur at work or whilst travelling to or from work but elsewhere.

The frauds by employers are by far the most common.  Overservicing by health care providers is also a huge problem.  Employees making dodgy claims are a very small fraction of the above.

Note carefully there are severe penalties for defrauding the workers compensation system.

How long will it take to get workers compensation?

The workers’ compensation insurer is required to make a decision within a few days of receiving the claim. You will hopefully be able to provide evidence of witnesses, complaints made by you or co-workers, injury reports and medical attendances.

The most important thing though is to report your injury as soon as possible after you realise your problem is work related. Delay can cause a denial of your claim.  (However sometimes it can take a long time for you to work out you have a work related condition.) The employer must provide a claim form and send that form to the relevant workers compensation insurer.  If there is no dispute that the injuries were the liability of the employer then liability should be accepted in as little as 7 days.

Sometimes there are bad feelings about a claim being made. Either the worker feels guilty or the employer is cranky about it.  Remember this, just like a car you are vulnerable to damage or breakdown too. A person who bore a grudge against a car for being damaged would be crazy.  The same understanding should apply to you when you break down.  An injured person has to combat the feelings that come with injury and forced time off work.  It can be pretty depressing staying at home all day when you are used to being at work.  It is important that in order to get better and to keep things going well at home that these feelings are told to your doctors.  Burying these feelings and trying to deal with them by drinking or non prescription drugs can lead to terrible consequences for the worker and families.  An injured worker is still a worker so don't let this time away from work wreck a life.

Our schemes of workers compensation in Australia can be tough but are generally aimed at being fair.

 Why do I have to make a claim?

So you can obtain the benefit of the system to return to work and get looked after.  There are sometimes cases where the owner offers to “take care” of the injured worker if they don’t make a claim particularly if the employer has not paid the proper insurance. Sometimes employers tell the worker they cannot make a claim (e.g. did not happen at work when it was really a work related activity) or will not give the worker a claim form.  This is not right even where the employee is said to be a sub-contractor (subbie).  That worker may be only a subbie for tax and super purposes but subbies who do nearly all their work for one head contractor are employees for workers compensation purposes.  If you are unsure call a lawyer.

Some injuries are attributable to the nature and conditions ie repetitive method of work even with several different employers and have taken a long time to be obvious. Sometimes a worker seeks treatment but forgets to tell their doctor that they work in an occupation where such injuries happen. A lot of workers have taken sick leave to get better but when they find they cannot do the same work anymore the employer gets rid of them. Sometimes they have even left a job due to pain without realising the pain was caused by work. Don’t let that happen to you. Even if the employer has no insurance you should still claim to the workers compensation authority in your state. It will arrange compensation and sort out the employer. You will also need independent legal advice. 

How do I pay for the legal costs?

You should read our general information on costs here

This information applies generally to cases that have to go to court.  In workers compensation each state has different rules effecting how you will pay and what the insurers will pay for.  Your solicitor is obliged to explain this carefully to you.

What happens if my compensation is paid late?

This one of the major problems that come up.  The claim has been accepted but instead of coming in on the day you usually get your pay it is a day or two late. That can have very costly consequences like your account being overdrawn when your rent or payments come out.  You incur late fees and when things are tight that hurts.  Any dispute like that can be sorted out by calling the workers compensation authority in your state and telling on the insurer for being late. Also consider changing the days that payments come out to account for your changes in circumstances.