Has The Workers’ Compensation Insurer Declined

 In Blog, Latest News, Workers Compensation Claims

What Does It Mean If The Workers’ Compensation Insurer Declines Liability For My Claim?

It does not mean that you do not have a valid workers’ compensation claim. That question can really only be determined by an Arbitrator of WorkCover WA. If the insurer declines liability for your claim, this means that after investigating the factual and medical evidence with regards to your claim, the insurer has decided you do not have a valid claim.  But this is only the insurer’s decision, or opinion based on the available evidence, it does not mean that your claim will fail. However, it does mean that you have a dispute and to resolve that dispute, you will need specialist legal advice as to how to challenge the insurer’s decision and build your case based on the factual and medical evidence.

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A personal injury lawyer is the best person to do this on your behalf.  An insurance company will not look at the evidence in the best possible light and will look for evidence which may suggest you have a pre-existing condition or that you suffered the injury outside of the workplace. It may be the case that you have a pre-existing condition, however this does not mean that your case would fail or that you are not entitled to workers’ compensation payments. Ultimately that is for the Arbitrator to decide.  Your personal injury lawyer will take statements from yourself to determine what actually happened and statements from any witnesses to corroborate your evidence. He or she will also obtain medical evidence from your treating doctors and specialists and more than likely from a medico-legal specialist, asking the relevant questions with regards to the issues in your claim. This evidence is obtained with a view to commencing the dispute resolution process at WorkCover WA. This is generally a two stage process. Firstly, an Application for Conciliation is filed and a Conciliation Conference listed before a Conciliation Officer.  This is where the issues with regards to your claim are discussed and are attempted to be resolved. This is also where settlement negotiations are likely to occur to resolve your claim. What your claim is worth requires specialist legal advice and it is recommended that you have legal representation at your Conciliation Conference.

If your  case does not settle, then the Conciliation Officer issues a Certificate of outcome and you must then decide whether you wish to file an Application for Arbitration. This must be done within 28 days of the Certificate of Outcome.  The time frame from making an application to Arbitration Hearing can be anywhere from 4-9 months depending on the complexity of your matter. There may be opportunities for your case to settle prior to the hearing, however should your matter proceed to hearing, an Arbitrator will then make a decision as to whether your claim should be accepted or declined, based on the evidence available.

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