The last thing you need after sustaining an injury at work, is being provided with a letter from your insurer which states “Important Notice about your claim under section 78 of the Workplace Injury Management and Workers Compensation Act 1998.“
This notice from the insurer sets out that your rights and entitlements such as your weekly payments or medicals will come to an end.
If you have lodged a worker’s compensation claim after having sustained an injury during the course of employment and have received such notice from your insurer, you should contact Turner Freeman Lawyers and provide a copy of the notice so that we may challenge this for you.
An insurer must inform you by notice that your weekly wages and/or treatment will be declined. A section 78 notice informs you that your entitlements under the Workers Compensation Act 1988 and under the Workplace Injury Management Act advises that you are not entitled to weekly payments, reasonable medical and treatment expenses, or even surgery for your injury whether this be psychical or psychological.
In accordance to the Workers Compensation Regulation 2016, clause 38 (1)(h), the insurer must provide a reasons and outline the following:
- the effect of the decision
- the worker’s rights of review of the decision
- the procedure for requesting a review, and
- legal and other services that may be available to provide advice or assistance in relation to the dispute.
The document outlines and provides reasons the insurer has gathered to bring the entitlement to an end. Often, insurers tend to cut weekly and medical expenses leaving you with an injury and financial strain.
Some possible reasons an insurer will provide include the following:
- You do not meet the legal definition under Worker compensation Act as being a “worker”;
- Insurer states that your injury did not arise out of employment as required by section 4 of the Workers Compensation Act 1987;
- The insurer states under section 9A, that your employment was not a substantial contributing factor to your injury;
- The insurer does not agree that employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of your injury by way of section 4(b) of the Workers Compensation Act 1987;
- The insurer states you have an pre-existing injuries/conditions which are causing ongoing symptoms;
- Your doctor has certified you to return to employment.
An insurer must provide relevant reports on the basis they are declining your claim. This includes reducing weekly payments by section 78 notice. Documents that the insurer is to include as part of their decision is not limited to medical reports, clinical notes, investigations rehabilitation and health service provider’s reports that contain information relevant to the declinature The notice must list all documents the insurer forms their reasoning upon.
Internal Review with the Insurer:
Lawyers assist if there is a dispute about liability for your claim. Should you receive such notice, with the assistance of Turner Freeman lawyers, we would need to be investigate our injury by way of an Independent Medical examination, and treating doctor’s report so that declinature can be overturned. Once a review is lodged by your lawyer at Turner Freeman, insurers have 14 days to provide a response.
Should the insurer change their mind, then your entitlements will be re-activated; however should the insurer maintain their declinature, Turner Freeman lawyers will take your matter to the Workers Compensation Commission, now known as the Personal Injury Commission.
The new Personal Injury Commission
On the 1 March 2021, the new Personal Injury Commission replaced the Workers Compensation Commission and State Insurance Regulatory Authority (SIRA) by becoming a new single tribunal for all dispute resolution services. The Personal Injury Commission is an independent tribunal which deals with disputes regarding Workers Compensation Act and compulsory third party (CTP) insurance claims.
With the help of your lawyer at Turner Freeman, we will lodge your Application to resolve your dispute at the Personal Injury Commission. Your lawyer will attend to a conciliation and Arbitration to have your workers compensation dispute overturned.