Your obligations in a workers compensation claim – what workers need to know – Employee Benefits & Compensation

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.

1. 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.

2. 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.

3. Injury Management Planning⁶

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.

4. Case Conferencing⁷

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.

Footnotes

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.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.