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Workers Compensation “Reasonably Excused” – what does that mean?

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Workers Compensation “Reasonably Excused” – what does that mean?

We acted for Jill who was a retail assistant in a large company. A couple of things happened at work which were outside her control, which caused her to develop severe stress and anxiety. Finally, Jill visited her doctor who put her off work.

Jill notified her employer that she had sustained a psychological injury, and required time off work to get treatment. The workers compensation insurer sent her a letter soon after, telling her the claim was “reasonably excused”. Jill was upset about this letter, and came to Brazel Moore Lawyers for help.

Where a worker is injured in the course of employment, their employer will start a process to begin workers compensation payments for that worker. First, an injury notification will be made to the workers compensation insurer. Then the insurer will then examine the details of the injury notification, the injury itself, and possibly make further enquiries. The worker will be contacted by the insurer very soon after to let them know that “provisional” workers compensation benefits will be paid whilst the claim is being properly determined.

Provisional benefits can be paid for up to 12 weeks. During this period, the insurer is required to treat a claim as if it has been accepted, whilst they use the time to investigate the claim further and work out whether the claim is legitimate. The point of a “provisional liability period” is that it is not always possible to find out about an injury straight away, and while the insurer is busy investigating, the worker is in need of support and income. Provisional payments are to ensure the worker has this support whilst the claim is being looked into. For Jill and many others, this doesn’t happen.

There are rules about when workers compensation insurers can “reasonably excuse” a claim. This may be where the the initial medical certificate (a “workcover certificate of capacity”) does not have enough information.

Brazel Moore Lawyers was able to immediately identify the errors in the medical certificate, explain to Jill’s doctor what needed to be changed, and assist Jill in locating other supporting documentation. Brazel Moore Lawyers submitted a new set of documents for Jill, and the insurer agreed it could no longer “reasonably excuse” her claim. She began receiving weekly benefits and medical expenses, and later her claim was formally accepted.

Jill is now receiving the treatment and income support she needs whilst she recovers and returns to work.

If you have had a claim rejected and you aren’t sure why, contact Brazel Moore Lawyers today on 02 4324 7699 for free assistance and advice.