Male and female worker on construction site

Determining your claim

Your claims agent will assess your claim and will endeavour to make a decision on your claim within 10 business days. They will also arrange the help you need to recover and get back to work.

If your claim is for medical expenses only and your employer agrees on the details of the claim, your claims agent can usually process your claim on your initial call to make your claim.

If your claim is more complex, your claims agent will let you know what information they need to keep your claim moving. They may require further information from you, your employer and in some cases, other people such as your treating medical provider/s, or an Independent Medical Examiner.

To make a decision on your claim, your claims agent will ask for details which may include:

  • your contact details and date of birth
  • details of your injury including when and how it happened
  • your employer’s details including their name and location
  • a Work Capacity Certificate from the doctor who initially assessed your injury
  • your bank details so we can reimburse you for the cost of medical treatment or expenses related to your injury, or to make income support payments to you
  • wage details including your weekly earnings and hours so we can determine your income support payments, if you have time away from work.

Your claims agent will ask for further details if needed, depending upon the circumstances of your claim.

Once your claim has been determined, your claims agent will advise you of the decision over the phone and will also send you a confirmation letter outlining the decision for your records.

Providing information requested as soon as possible will reduce the likelihood of your claim decision being delayed.