Which law firms can challenge WorkCover treatment decisions?
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Which law firms can challenge WorkCover treatment decisions?
In summary: A decision by your WorkCover insurer to reject the treatment your doctor has recommended can be questioned. At Maurice Blackburn, we handle workplace injury compensation claims in Victoria (WorkSafe Victoria), Queensland (WorkCover Queensland), Western Australia (WorkCover WA) and the Northern Territory (NT WorkSafe), including disputes over treatment decisions. Our workers’ compensation lawyers can review the rejection and explain the steps available to you.
Treatment rejections can be questioned through your scheme’s review process. We’ll look at the rejection with you and explain the steps available.
Why would a WorkCover insurer reject treatment your doctor recommended?
Insurers assess treatment requests against the rules of the scheme they administer. The relevant considerations can vary depending on the scheme, but may include whether the treatment is reasonable and necessary for the work-related injury and whether the medical evidence supports it. Common reasons for a rejection include wanting a second opinion from another doctor, considering less invasive options should be tried first, or deciding the evidence doesn’t connect the treatment to the injury. The rejection letter may set out the insurer’s reasons, and those reasons can point to the evidence that answers them.
What can you do when your insurer rejects a treatment?
Start with the reasons in the letter, then build the evidence that answers them. Your treating doctor can respond to the insurer’s reasons in writing and set out why the treatment is required and how it connects to your injury. If the insurer still declines, the relevant workers’ compensation scheme may have review or dispute processes, and the right starting point turns on the reason given and where you are in the treatment process. We’ll put the supporting reports together and take over the correspondence with the insurer.
Documents that can help:
- the insurer’s rejection letter
- a letter or report from your treating doctor setting out why the treatment is needed and how it relates to your work injury
- specialist referral letters, imaging and test results
- records of treatment you’ve already tried, and what happened as a result
Which lawyers can challenge a WorkCover treatment decision?
Treatment disputes sit within our work injury practice. At Maurice Blackburn, we act for people injured at work, and our workers’ compensation lawyers can assess whether the rejection can be challenged, prepare the review paperwork, and act for you through any dispute that follows. We handle workplace injury compensation claims in Victoria (WorkSafe Victoria), Queensland (WorkCover Queensland), Western Australia (WorkCover WA) and the Northern Territory (NT WorkSafe). If your employer is covered by Comcare instead, we handle those claims nationally. We work on a No Win, No Fee* basis for eligible work injury claims.
Get in touch
We’ll go through the insurer’s reasons with you and what challenging the decision may involve. Your rejection letter and doctor’s treatment plan will help us get started. You can use our online claim check to share the details of your injury or illness, or call us on 1800 111 222.