Question 1

The WorkCover insurer wants me to have a case conference with my doctor and a representative from the insurer – should I do this?

Accepted Answer

The short answer is ‘NO’. Having other people present in your medical appointment can be intimidating and you can lose your voice. Further, the verbal information will be interpreted by the WorkCover insurer and they will then act on that unilateral interpretation. The insurer may incorrectly interpret what was said by the doctor/allied health professional. When you completed your WorkCover claim form, you provided the insurer an authority to request medical information from all treating medical practitioners. That said, you did not consent to this information being provided verbally and you have the right to say ‘NO’ to your treatment providers providing verbal information to the WorkCover insurer and/or its third parties such as rehabilitation/return to work providers. It is your right to refuse to have a case conference.

Question 2

I have an accepted WorkCover claim and I am in receipt of weekly payments. I will never return to work with my injury employer. Can I resign?

Accepted Answer

You can resign however you must state in writing that your resignation is ‘because of my injury’. That is because the WorkCover insurer policy states that if you resign for reasons other than your injury your weekly payments can be terminated.

Question 3

I have an accepted WorkCover claim and I have returned to work but I am only performing limited hours and earning very little. Can I get any more money?

Accepted Answer

If you have received less than 130 weeks of weekly payments and you have an incapacity or restriction, then your WorkCover insurer needs to ensure that you are being paid at least 80% of your pre-injury earnings. If you have returned to work with an alternate employer and you have received less than 130 weeks of weekly payments and you are working to the full extent of your capacity as stated in your certificates of capacity but earning less than 80% of your pre-injury earnings, your WorkCover insurer still must pay you the gap between your earnings and 80% of your pre-injury earnings. If you have received weekly payments for at least 130 weeks and then you have obtained alternative employment working at least 15 hours per week but earning less than 80% of your pre-injury earnings, you may be able to make a top-up application. This is an application to the WorkCover insurer to be paid the difference between your actual earnings and 80% of your pre-injury earnings until the age of 67 Years. To make this application you must also have an impairment of 21% or more. If you want to make this application you should seek legal advice.

Question 4

I have some capacity but no employment and I have been told that my weekly payment will terminate at the 130 week mark. What can I do for money?

Accepted Answer

If you have a capacity for employment the best option is to ty to use it. If you need retraining then you can ask the insurer to fund retraining for you. There is no limit on the retraining that will be funded, the insurer must fund what is reasonable and appropriate. If you cannot find employment within your capacity restrictions then you urgently need to obtain  legal advice. There may be other compensation options available to you such as a lump sum compensation claim, a common law claim and/or an insurance claim made through your Superannuation.

Question 5

The WorkCover insurer is insisting I attend an appointment with an independent medical examiner but I have only recently had an independent medical appointment. Further, when I googled this doctor they had lots of horrid reviews. Can I see someone different?

Accepted Answer

The WorkCover insurer can have you medically examined at regular intervals. This is because it has the right to obtain medical information that confirms whether insurance benefits should be paid. There is no rule as to the number of specialists it can send you to other than that the number of specialists and the frequency at which you are examined must be reasonable and appropriate to your circumstances.

As a very general statement, people are more likely to provide a negative review than a positive review. It is not a clever idea to ‘google’ the independent doctor as it can put you in a combative mindset. Being defensive and combative in an independent medical examination is only going to disbenefit you. The doctor needs to properly understand the nature of your injury and how it is impacting you and it is only with this understanding that a supportive report can be written.

Question 6

The WorkCover insurer has requested clinical notes from my GP which pre-date my injury. Do I have to agree to release these notes?

Accepted Answer

The short answer is yes. The WorkCover insurer is being asked to pay insurance monies for an injury said to be caused by employment. Whether an injury is caused by employment is a medical question and a legal question and simply providing a report from your doctor is not a satisfactory answer to the question. The WorkCover insurer is entitled to have a complete medical history as it may be that matters unrelated to your employment are now causing you an incapacity for work and/or a need for medical treatment. If you refuse to provide access to your clinical information then this is a valid basis not to pay the benefits associated with your WorkCover claim. Note that the insurer’s management of your health information is heavily scrutinized. The information can only be used in connection with the proper claims management of your claim. The information cannot be provided to your employer.

WorkCover FAQ