The last thing you need when dealing with physical and emotional trauma from a workplace injury is ReturntoWork South Australia (RTW), rejecting your claim for workers compensation. Believe it or not, this happens frequently and the good news is that you can appeal RTW’s decision.
The information below provides information on what steps to take if your workers compensation claim has been rejected.
Reasons why ReturntoWork rejects workers compensation claims
There are various reasons why workers compensation claims are sometimes rejected. The most common reasons are that RTW believes an injury was not directly work related, resulted from a pre-existing medical condition, or that the claim was lodged out of time.
If RTW has rejected your claim, we strongly recommend you speak with one of our experienced workers compensation lawyers to discuss whether you have grounds to appeal RTW’s decision.
Lodging an appeal with the South Australian Employment Tribunal
If your claim has been rejected, a claims agent from RTW SA will contact you to discuss the reasons why and alternative options to workers compensation. A letter of determination containing the reasons why your application was rejected will also be sent to you.
In South Australia, the Employment Tribunal (SAET) has authority to review workers compensation claims rejected by RTW. After receiving notice their claim was rejected, a worker has one month to apply to have the decision reviewed.
If you want to apply to SAET for a review, you will need to lodge an A02 – Application for Review (Return to Work) online. This form can be found on SAET’s website. You must include a detailed explanation as to why the decision to reject your claim was wrong and also attach evidence that supports your explanation such as medical reports and witness statements.
If you have lodged an application for review, we strongly recommend you still seek legal advice as the grounds for rejecting your claim may be based on misinterpretation of legislation, medical evidence, or reliance on incorrect data contained in RTW’s system. An assumption should not be made that just because the RTW made a determination, that it must be correct, and therefore not worth reviewing.
A copy of your application for review will be sent to RTW and your case will be allocated to a SAET Commissioner. After receiving a copy of your application for review, RTW has 10 business days to either confirm or vary their decision to reject your compensation claim. They must notify SAET and yourself of their decision. You need to consider whether to accept the varied decision. If you accept the varied decision, or are dissatisfied with the variation, you can contact your SAET Commissioner to discuss what happens next.
If RTW confirms their decision to deny your claim, SAET’s dispute resolution process will begin.
What is involved in SAET’s dispute resolution process?
Most matters go through the following steps:
- Pre-conciliation
- Initial directions hearing
- Conciliation conference
- Settlement conference
- Mediation
- Hearing and determination
- Referral to an Independent Medical Adviser
We recommend you seek legal advice regarding the above process before it commences in order to give yourself the best chance of a successful outcome.
If you are unhappy with the outcome of SAET’s review of your matter, you can lodge an appeal with the South Australian Employment Court. However, this can be a complex and daunting task so we strongly recommend you seek assistance from a lawyer who has experience in preparing appeals.
Conclusion
Unfortunately, a person’s claim for workers compensation sometimes gets rejected. If you find yourself in this situation, it is important to understand why your claim has been rejected so that you can apply for a review of the decision.
Your application to review a decision must contain all the necessary information required for the best chance of success. For this reason, it is vital you seek legal assistance with your application for review.
If you or someone you know wants more information or needs help or advice, please call us on 0401 234 710 or email [email protected].