WorkCover claim acceptance letter – what does it actually say?
Once you’ve lodged a WorkCover claim, the WorkCover insurer will spend some time processing the claim before ultimately making a decision to either accept or reject the claim.
If they accept the claim, then you’ll receive a letter from the insurer confirming acceptance of the claim and providing you with some general information.
The rest of this page will look at a WorkCover claim acceptance letter and will point out the important points.
Below you’ll see each page of a typical WorkCover claim acceptance letter.
We’ve added numbers to different sections of the letter, with text below explaining each numbered section.
Table of Contents
1. This is the WorkCover insurance company that is responsible for the claim.
There are a number of WorkCover insurers in Victoria.
It could be Allianz or Gallagher Bassett, EML or Xchanging (DXC).
Or, you may work for a company that is a self insurer (Eg: Coles supermarkets).
The WorkCover insurer will remain the same in most cases throughout the life of your claim. On rare occasions, claims are moved between insurers.
2. This is your WorkCover claim number.
You should keep a copy of this handy because it is a very important and a number that you’ll be required to use during the life of your WorkCover claim.
You will need to have it handy if you call the insurance company, and you’ll need to have it handy if you send them material such as invoices and receipts for payment.
You’ll find that your WorkCover claim number will be printed on most of the correspondence you receive from the insurer.
3. This section outlines what has been accepted.
It will also confirm what the injury (or injuries) is that they have accepted.
4. This section titled ‘action required’ advises you as to what actions are required by you.
The important things here is, that if you have a claim for weekly payments, you should continue to provide certificates of capacity to the WorkCover insurer at least every 28 days if your ability to work has been impacted, whether totally or partially, as a consequence of your work related injury.
You will need to complete the workers choice of occupational rehabilitation provider form and return it to the insurance company.
Generally speaking the insurer will give you a choice of three occupational rehabilitation providers that you can choose from.
Finally, you’ll see that it says that you are to make reasonable efforts to actively participate in to return to work planning and cooperate with your employer and occupational rehabilitation service provider (where relevant)
You can read more about what this actually means here.
5, 6 and 7 outline what your options are if the WorkCover insurer makes a decision that you disagree with and you wish to contest that decision.
This decision could be anything from the insurer refusing to pay for physiotherapy treatment or medication, to rejecting liability for a particular injury in relation to your impairment lump sum claim.
You’ll see that the options outlined are; pursue the matter to conciliation, the WorkCover division of the Magistrates court, or ask the insurer to perform a review.
8. This section is where your claims managers name, and other contact details will be listed
You may not have this claim manager throughout the duration of your claim.
In fact, you might have been told by other people on WorkCover that it is quite common for your claims manager to change as your claim progresses, and when you hit different stages of your WorkCover claim it is quite possible that the person managing your claim may change.
But for now, this is the person that is responsible for managing your claim.
This is the person that you’ll need to speak to if you have any questions regarding the payment of medical and like expenses and weekly payments.
Any invoices for payment of medical expenses should be sent to this person unless you’re told otherwise.
And your certificates of capacity should be provided to this person.
9. This section goes into more detail about weekly payments and what can impact weekly payments.
It details how your pre injury average weekly earnings are calculated.
10. This outlines your entitlement to the payment of medical and like expenses and how you can go about claiming reimbursement for expenses.
11. This is an important point in relation to the payment of medical and like expenses
It says that you may not necessarily receive the full amount of a medical expense claimed and that you may receive a lesser amount.
This is because the WorkCover insurer pays for medical like expenses according to the WorkSafe schedule fees (i.e. fees are capped).
12. This is another important section and outlines your responsibilities with regard to returning to work
It says that you need to actively participate in return to work planning and cooperate with your employer and the insurer and actively use any occupational rehabilitation services provided and cooperate with the service provider.
Further, it says that you must make reasonable efforts to return to work at your workplace or another place of employment.
Keep in mind however this does not extend to returning to work if you are not able to do so taking into account your work related injury.
You are not able to be forced back to work if you are not medically ready to do so (if supported by medical opinion).
The WorkCover claim acceptance letter is a letter that you will receive if your claim has been accepted after the initial claim to termination period.
If your claim has been rejected, you’ll receive a rejection letter.
The acceptance letter will confirm what your claim has been accepted for, whether that is for medical and like expenses only or medical and like expenses and weekly payments.
It will also provide you with some general information about claiming medical and like expenses, weekly payments (if appropriate) and your return to work obligations (again if appropriate).
If your claim has been accepted and you want to read more about what you’re entitled to, this page should assist.
If however your claim has been rejected, we recommend visiting this page.