If your WorkCover claim has been rejected, you are not alone. Many Victorian workers experience this, often while they are still recovering from an injury. A rejection can feel unfair, but it does not necessarily mean the end of your claim. In many cases, there are clear steps you can take to have the decision reviewed or overturned.
This article explains the most common reasons WorkCover claims are rejected, what to do next, and how a lawyer can help you move forward.
Why WorkCover Claims Get Rejected
WorkCover claims in Victoria can be refused for several reasons, many of which have nothing to do with the seriousness of your injury. Insurers may reject claims because:
- The claim form or supporting documents were incomplete or missing.
- There is not enough medical evidence to show the injury is work-related.
- The insurer disputes how or when the injury occurred.
- The claim was not lodged within the required timeframe.
- The insurer does not accept that the injury arose out of or in the course of employment.
These rejections are often based on limited information or misunderstanding. In many cases, once the evidence is clarified or new information is provided, the decision can be reviewed successfully.
Your Options After a Rejection
If your claim is rejected, the first step is to read the insurer’s decision letter carefully. The insurer must provide written reasons for the decision. Understanding those reasons will help you decide how to respond.
- Review the decision and gather more evidence
Check whether the insurer has misunderstood your medical reports or missed key details. You can strengthen your case with updated medical certificates, workplace records, or statements from colleagues who witnessed the injury. - Request conciliation through the Workplace Injury Commission (WIC)
If you disagree with the decision, you can apply for conciliation through the Workplace Injury Commission. This is a free, independent process where you and the insurer meet with a conciliator to try to resolve the dispute. You usually need to apply within 60 daysof the insurer’s decision, so it is important to act promptly. Many rejected claims are resolved at this stage once the missing evidence or information is provided. - Seek legal advice early
A WorkCover lawyer can review your rejection, help you prepare your evidence, and represent you during conciliation. They can also identify whether you may be eligible for other entitlements, such as a permanent impairment benefit or a common law claim. Getting legal advice early gives you the best chance of a positive outcome.
What Happens at Conciliation
Conciliation is not a court hearing. It is an informal meeting run by the Workplace Injury Commission to help both sides reach an agreement. You can bring a lawyer or support person with you. The conciliator reviews all information and helps both sides find a fair solution.
If an agreement is reached, the insurer may agree to accept your claim, pay outstanding benefits, or arrange further medical assessments. If conciliation does not resolve the issue, you may be able to take your dispute to a medical panel or court for a final decision.
When to Get Legal Help
If your WorkCover claim has been rejected, or if your payments or medical treatment have been stopped, you should get legal advice as soon as possible. Strict time limits apply to WorkCover disputes, and early advice ensures you do not miss your opportunity to challenge the decision.
Most WorkCover lawyers, including Ryan Carlisle Thomas Lawyers, work on a no win, no fee basis. This means you will not pay legal costs unless your claim is successful.
If your claim has been refused, do not give up. With the right support and guidance, you may still be entitled to compensation and treatment to help you recover and return to work.
Quick FAQs
Can I appeal a WorkCover decision in Victoria?
Yes. You can apply for conciliation through the Workplace Injury Commission to have the decision reviewed.
How long do I have to dispute a WorkCover rejection?
You generally need to apply for conciliation within 60 days of the insurer’s decision, so do not delay in seeking advice.
Do I need a lawyer for conciliation?
It is not compulsory, but having a lawyer can make the process smoother and improve your chances of success.
