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Claim FAQs

Do I have to see a doctor before I make a claim?

We can start the claim process before you have had your injury assessed by a doctor and you've been provided with a Work Capacity Certificate.

Do I need to complete a claim form?

You don’t need to complete a claim form to start a claim and for some claims you won’t need to complete a claim form at all. Your claims agent will let you know if a form is needed. If a claim form is needed, a mobile case manager will help you and your employer to complete it during the initial face-to-face visit.

How long will it take to make a decision on my claim?

The time it takes to make a decision on a claim depends on the circumstances of each case.

Your claims agent will let you know as soon as possible whether your claim has been accepted as (usually within 10 business days).

In some circumstances, a decision can be made while you’re making your claim over the phone. In other cases, your claims agent may need to obtain additional information from you or your employer, your treating doctor/s, or arrange the opinion of an independent doctor in writing or in person.

It’s often the case that further information will be requested. Speak to your claims agent about the likely timeframe to process your claim.

What about my pay and medical expenses while I’m waiting on a decision on my claim?

If you’re off of work or are incurring medical expenses for treatment while your claim is still being decided, then you have some options to consider:

  • Medical treatment invoices – Your medical treatment providers may be prepared to invoice you pending the outcome of a decision on your work injury claim (instead of requiring payment immediately). If your claim is accepted then at that point we can pay these accounts.
  • Interim payments – If your claim will take longer than 10 days to determine, your claims agent will speak to you about interim payments to cover your income and medical expenses. It’s important that you discuss this with your claims agent as the payments will be recovered from you in the event that your claim is not accepted.
  • Sick leave or annual leave entitlements – If your claim hasn’t been accepted, speak to your employer about whether you can access other entitlements such as sick leave or annual leave entitlements.

How will I know if my claim is accepted?

Your claims agent will contact you and your employer either by phone or in writing to let you know if your claim has been approved and what additional information they need to keep your claim moving.

If your claim is not accepted, your claims agent will let you know the reason/s for their decision and what options are available to you. See ‘What happens if my claim is not accepted?’  below for more information.

My claim has been accepted, what do I need to do?

If your claim has been accepted, your claims agent will let you know what information they need from you to continue moving your claim along. This may include confirmation of wages, a Work Capacity Certificate etc.

What happens if my claim is not accepted?

Your claims agent will aim to discuss the reason why your claim hasn’t been accepted and will explain what alternate options may be available to you over the phone. They will also send your determination out in writing for your records.

If you’re unhappy with the decision on your claim, you’re encouraged to contact your claims agent to discuss this and you’re also entitled to ask for a review of the decision.

Other services that are available to help you are the ReCONNECT program, Centrelink, and your GP.

How do I find out about the status of my claim?

When you make a claim, you’ll receive an SMS or an email providing you with a claim number and the name and contact details of your claims agent. You can contact your claims agent at any time throughout your claim for details of where your claim is up to or for further information.

How do workers of self-insured businesses make a claim?

Workers of self-insured businesses will need to contact their employer to report an injury or make a claim.