WorkCover claim rejected or closed in Queensland: what happens next?

What should you do first after receiving a decision?

Start by keeping the decision itself. Save the letter or email, and note the date you received it, because review time limits are generally counted from receipt of the decision letter.

• Work out what the decision is about: whether the claim was not accepted, whether payments have stopped and the claim has been closed, or whether it concerns one particular part of the claim.
• Write down any questions you have, and the date and substance of any phone call in which the decision was explained.
• Keep seeing your treating doctor about your injury. WorkCover Queensland’s guidance on claims that are not accepted or are closed also lists other avenues for treatment and support.

If you have not yet lodged a claim, or want to understand the steps that came before the decision, our guide on how a Queensland workplace injury claim is made and assessed explains the usual process.

How do you obtain and read the written reasons?

WorkCover Queensland’s current guidance says that if it cannot accept a claim, it will call to explain why and send a letter setting out its reasons, called a reason for decision letter. The same guidance says that if you are unhappy with a decision, you may be able to ask for a reason-for-decision letter within 20 business days. Whether that applies, and when the period starts, can depend on the decision, so check the letter itself and the official guidance.

When reading the reasons, look for:

• what exactly was decided, and the date of the decision;
• which requirement the insurer says was not met. WorkCover Queensland says it considers matters such as whether the claim was made in time, whether you are a Queensland worker, how and where you were employed, how the injury happened, and whether work was a significant contributing factor;
• which medical and other evidence the insurer relied on; and
• any information in the letter about review rights.

How does the Workers’ Compensation Regulatory Service review work?

Some insurer decisions can be reviewed by the Workers’ Compensation Regulatory Service, referred to as the Regulator. WorkCover Queensland describes reviews as handled independently by the Regulator. It also says applying is free, and that a review is not part of a court process, so you will not attend in person.

Not every decision can be reviewed. The written reasons and the official guidance are the starting point for working out whether review is available for your decision.

Is there a time limit to apply for review?

WorkCover Queensland’s current guidance says you can generally apply for review within three months of receiving your decision letter. The time that applies to you can depend on the decision and your circumstances, so check the letter and the official source, and ask if you are unsure when your period started.

What evidence is useful to organise?

A review considers the issues in the decision, so it helps to have the relevant documents together and in date order:

• the decision letter and any written reasons;
• all Work Capacity Certificates;
• medical material, such as reports, referrals, test results and treatment records;
• employment and wage records, such as contracts, payslips, rosters and timesheets;
• incident reports and other records of how the injury happened; and
• relevant correspondence with WorkCover Queensland, your employer and treating practitioners.

Keep original files, emails and attachments where you can, and do not add to or reconstruct records you are unsure about.

What can an independent review do?

According to WorkCover Queensland, after reviewing the claim the Regulator will let you know the outcome, and it might tell the insurer to change its decision, ask for more information, or confirm the original decision. A review does not guarantee that the decision will change.

Some disagreements about medical questions follow a different path. Our guide to the Medical Assessment Tribunal explains that separate process.

Is a rejected statutory claim the same as a common-law claim?

No. A statutory WorkCover claim concerns benefits under Queensland’s workers’ compensation scheme. A common-law claim is a separate claim for damages, generally based on an allegation that an employer’s negligence contributed to the injury, and it has its own requirements, procedures and time limits.

Because the questions are different, the outcome of a statutory claim should not be treated as answering whether a common-law claim is available, or the reverse. Each needs to be considered on its own facts and evidence.

When might individual legal advice assist?

You do not need a lawyer to read a decision or to apply for review. Individual legal advice may assist if you are unsure what the decision means, whether it can be reviewed or when your time period started; if the decision turns on disputed facts, worker status or medical evidence; or if you want to understand how a statutory decision relates to any common-law rights.

The firm’s Queensland workers’ compensation page sets out related general information.

Official sources

• WorkCover Queensland: How to make a claim
• WorkCover Queensland: If your claim isn’t accepted or is closed
• WorkCover Queensland: How your claim is decided

This page is general information about Queensland workers’ compensation, not legal advice about your situation. Deadlines and options can depend on the particular decision and your circumstances, and official guidance and the law can change.