Your obligations in a workers compensation claim – what workers need to know
Published on May 7, 2024 by Amelia Frisch and Hanaan Indari
You have lodged a workers compensation claim and liability has been accepted by the insurer. Great! But now, what else do you need to know?
Navigating the workers compensation system and establishing a relationship with the insurance company can be daunting at first. So, it’s important to understand your obligations under the legislation and what is expected from you during this process.
This article covers some of the general expectations which you should be aware of while pursuing your workers compensation claim.
- Point of Contact
At the beginning of your claim, the insurance company will assign a case manager to coordinate your claim. They will be your main point of contact for any payment queries as well as medical treatment and expenses.
If you are still employed and/or working with the company at which you have sustained your injury, you may also have a return-to-work coordinator. They will be your main contact for any issues that may arise while at work and will help coordinate your recovery at work. This may include organising workplace modifications or equipment to assist you undertake your tasks.
- Certificates of Capacity
As an injured worker, you are responsible for providing a valid Certificate of Capacity to the insurer to be eligible for weekly payments [1].
Your Certificate of Capacity must include a diagnosis. In the event you have a psychological injury, symptoms like anxiety or stress may suffice for the first Certificate of Capacity until you have seen a psychologist or psychiatrist, but once a diagnosis is made, it is important that your nominated treating doctor includes this on any Certificates moving forward [2].
While most of your Certificate of Capacity is completed by your nominated treating doctor, there are two sections that you are required to complete, namely, the injured person’s consent, and employment declaration [3].
- At section 1, there is an injured person’s consent that you must sign on each Certificate issued. This allows stakeholders including your nominated treating doctor and other health-related practitioners, the insurer, the employer and SIRA to exchange information for the purposes of managing your injury and claim.
- At section 3, the Certificate includes a declaration as to whether you are currently engaged in any form of employment, including self-employment or voluntary work [4]. It is particularly important when you are in receipt of weekly payments, to notify the insurer of any change in your employment that affects your earnings [5].
- Injury Management Planning[6]
Injury Management Plans (IMPs) are focused on providing you with appropriate medical treatment and an early return to work opportunity.
Following identification of a significant workplace injury, the insurance company is expected to develop an IMP within 20 working days.
The insurer develops these plans in consultation with you (the worker), your nominated treating doctor, and your employer, and may involve other stakeholders such as workplace rehabilitation providers.
The plan will be routinely reviewed in accordance with the statement of the plan, or when new information about your injury or treatment arises.
- Case Conferencing[7]
Case conferences bring together the worker, the nominated treating doctor, and other parties such as the insurer, the employer and workplace rehabilitation providers to discuss how to deliver the best possible return to work outcomes.
While a case conference cannot proceed without your consent, refusal should not be considered unless there are good reasons for doing so as it can be seen as obstructive.
The insurer is expected to provide a statement of the purpose and agenda for the case conference to all parties involved. You should not feel pressured to allow your case manager to sit in on your regular appointment/s with your doctor. The case conference can be scheduled at a time separate to your usual medical consultation, unless otherwise agreed by yourself and the doctor.
Need Advice?
Should you have any further questions or wish to seek advice on your claim, please do not hesitate to reach out for legal assistance. In NSW, the Independent Review Office generally awards a grant of assistance to fully cover your legal costs and disbursements.
Please note that this article does not constitute legal advice. If you are seeking professional advice on any legal matters, you can contact Carroll & O’Dea Lawyers on 1800 059 278 or via our Contact Page and one of our lawyers will be able to assist you.
[1] Section 44B Workers Compensation Act 1987.
[2] Section 11A(7) Workers Compensation Act 1987.
[3] SIRA: Workers compensation claims management guide: Understanding the Claims Journey.
[4] This section does not need to be completed by exempt workers – police officers, paramedics, firefighters, coal miners and workers who make dust disease claims.
[5] Section 57, Workers Compensation Act 1987.
[6] Section 60, Workers Compensation Regulation 2016; S12, SIRA Standards of Practice.
[7] S16, SIRA Standards of Practice.
