What to do if you’re injured on the job – and if your workers’ compensation claim gets rejected

What to do if you’re injured on the job – and if your workers’ compensation claim gets rejected

Accidents can happen anywhere – on the road, on holiday, at home or at work. Injuries sustained in any accident can affect your ability to do your job; however, if you’re injured while at work, you are eligible to file a Workers’ Compensation claim with your employer.

Depending on the extent of your injuries – as well as medical expenses and/or lost work time – you may be eligible for financial compensation.

Of course, not all injuries are eligible for compensation and not all claims are accepted. If you’re injured at work, it’s best to follow these steps:

1) File a report immediately. Even if an injury seems minor, it’s a good idea to document the incident in case problems develop after the fact. Employers may deny claims if there was too much time between the incident and filing (such as after a few days or over a weekend, when an incident could have happened somewhere else).

2) If anyone saw the incident – including co-workers, vendors, customers, etc. – ask any witnesses to make a brief statement about what happened so you can include what they saw in your report. If there are no witnesses to an accident, an employer may more easily deny a claim.

Once a report is filed, your employer and/or insurer may investigate the matter further by requesting reports or documentation from medical professionals, other witnesses, etc.

Types of rejections

As noted above, not all Workers’ Compensation claims are successful. If your claim is rejected, you’ll receive a letter from either your insurer or your employer rejecting your claim.

An insurer or employer can deny a claim for a number of reasons, but the most common arguments are:

1) The injury did not take place while you were at work

2) You had a pre-existing condition

3) You were under the influence of drugs or alcohol at the time of the incident

4) The injury took place at work, but outside of work hours

5) The injury was not severe enough to hinder your work abilities.

Getting help and disputing the decision

Just because an insurer (or employer) rejects a claim, it doesn’t mean you’re without options. There are still things you can do.

First, if you made a Workers’ Compensation claim and did not discuss your case with or get assistance from a lawyer, now is the time. A professional lawyer who is experienced in handling Workers’ Compensation cases will be able to assist you in exploring options and filing a review.

If you need to file a review, time is of the essence: In South Australia, you have just one month after receiving a rejection notice to file an application for review with the South Australian Employment Tribunal. (However, a lawyer may be able to request an extension on your behalf.)

Don’t assume that just because your claim is initially rejected, you can’t receive any compensation. An initial determination may be incorrect due to missing information, misinterpretation of medical records or oversights by an insurer or employer. The right legal team can help you identify issues and make your case.

For more detailed information about the process of making and filing a Workers’ Compensation claim, see this information from the Legal Services Commission of South Australia.

If you’ve been injured while at work or have any questions about filing a Workers’ Compensation claim, please contact us to speak with a member of our experienced legal team.