If you have suffered a work related injury or illness and intend to make a claim through the Victorian workers compensation scheme (WorkCover), you may find yourself asking, "can an employer dispute a WorkCover claim?" The short answer is yes. An employer may dispute your WorkCover claim for several reasons. This should not be a cause for concern, as it is within employer’s rights, and happens frequently. Some reasons an employer may dispute a workers compensation claim include:

• They disagree with the circumstances of the reported injury or illness
• They dispute that the injury or illness occurred at all
• They believe the employee does not have a legitimate injury or illness
• They suspect the injury or illness was pre-existing and not work-related
• They question the timing of the injury report.

As such, we recommend reporting any workplace injury or incident to your employer as soon as possible, preferably through a written incident report or online reporting system. Submitting an incident report at the earliest possible time ensures a higher likelihood of accuracy and reliability. Verbal reporting might cause details to be miscommunicated or forgotten, and there will be no written record for later reference. The incident report should include detailed information about the injury, circumstances, timing, and any potential witnesses.

Is there a time limit for my employer to submit my WorkCover claim?

Even if your employer disputes your WorkCover claim, they are still obligated to complete the Employer section of your WorkCover claim and submit it to their WorkCover insurer within 10 days of receiving it.

For mental injuries, your employer has 3 days to submit Part A of the WorkCover claim form to their insurer and 10 days to complete and submit Part B (the Employer section).

Irrespective of any dispute about your claim, penalties will apply if your employer does not adhere to these strict time limits.

In other words, if an employer disputes any part of a claim, it will be handled directly by the WorkCover insurer. The employer cannot use the dispute as a reason to withhold forwarding the claim to their WorkCover insurer or threaten the employee.

Therefore, you should contact a lawyer or WorkSafe immediately if any of the following occurs:

• Your employer delays or obstructs the process of submitting your WorkCover claim to their insurer
• The insurer has not sent you written confirmation of receipt of your claim within 12 days of you giving it to your employer
• Your employer refuses to complete or forward your WorkCover claim form to their insurer
• Your employer attempts to dispute your injury or the circumstances of your injury directly with you
• Your employer pressures you to withdraw or modify your WorkCover claim without involving the insurer.

If you have concerns about whether your employer has WorkCover insurance or if the claim will be forwarded on, you can lodge a copy of your claim form directly with WorkSafe.

What will happen if my employer disputes my WorkCover claim?

If your employer disputes any part of your WorkCover claim, the insurer will likely want a circumstance investigation report to better understand the details of your injury. This investigation, conducted by an external private investigator, may involve speaking with you or other employees and reviewing documents such as incident reports or employee records. The investigator may also visit the worksite to observe the system of work and will ultimately provide a report to the insurer with their findings.

During this process, you may be asked to participate in a discussion for the purposes of obtaining a statement. While participation is not compulsory and you can decline to give a statement, cooperating may be in your best interests. If there is a dispute and potential uncertainty about your injury's circumstances, your cooperation may improve the chances of your WorkCover claim being accepted. Otherwise, the investigation report and the WorkCover insurer may focus primarily on your employer's version of events, which could be unfavourable to your claim.

However, please note that once you provide a statement to the investigator, the insurer can rely on any part of it. Any minor errors or inaccuracies may impact your WorkCover claim and future compensation entitlements, such as weekly payments, an impairment benefit or a common law claim. As you are not legally required to provide a statement, it is important to carefully consider this decision before proceeding.

Before proceeding with providing a statement, you should seek legal advice. Ensure the investigator provides you a draft copy for review before it is submitted to the insurer. This is your opportunity to amend and/or remove any information that is inaccurate. You are not legally required to sign the statement and can provide the investigator with an unsigned copy. You should not sign a statement unless it is completely accurate, and you are entitled to decline to sign the statement.

What should I do if my employer disputes my claim?

Unless your employer has raised disputes or issues regarding your WorkCover claim directly with you or is refusing to forward your claim to their insurer (in which case you should seek legal advice or speak with WorkSafe), the best course of action is to await the insurer's decision on the outcome of your claim. During this time, continue with any necessary medical treatment and keep all receipts. If the insurer accepts your claim, you can seek reimbursement for reasonable medical expenses in accordance with WorkSafe’s schedule of fees. 

The insurer has 28 days from the date of receipt of a valid claim to provide you with a written notice, either accepting or rejecting your claim. Generally during this time, the circumstance investigation will be conducted, along with an independent medical examination arranged by the insurer, which you are required to attend.

If your claim is rejected, the first step to dispute the rejection is to go to conciliation. It is important that you lodge a request for conciliation within 60 days of a decision being made. Visit our 'Conciliation' webpage for further information.

If you, or someone you know, has been injured at work and need advice about your rights and entitlements through the WorkCover scheme, our team at Redlich’s Work Injury Lawyers can help. To arrange your free initial consultation and speak to a lawyer, contact us on (03) 9321 9988 or submit an online enquiry today.