What is your WorkCover claim status?

Summary

You can contact your WorkCover insurer (or employer if they’re a WorkCover self insurer) at any time and ask them to provide you with the status of your WorkCover claim.

There are a few occasions when you might consider doing so, which this page will explore.

When you want to know how many weeks of weekly payments you’ve had

When you have a WorkCover claim and you’re in receipt of weekly payments, usually the insurer will not provide you with updates as to how many weeks of weekly payments you’ve received.

And calculating how many weeks of weekly payments you’ve received yourself can in some instances be difficult.

Here’s why:

Weekly payments are not calculated in the way you probably thing they are calculated.

For example, if you’re a full time worker and you take four days off because of your work related injury but work one day of a week, taking those four days off will count as taking a full week of weekly payments.

This can make it a little difficult for a person to work out how many weeks of weekly payments they’ve received.

So you can contact the insurer and ask them for their calculation.

Finding out how many weeks of weekly payments you’ve received and got left (before the 130 week mark) will help you make financial plans.

Keep in mind that if you’ve got a capacity for work leading up to the 130 week mark, the insurer is likely to terminate your entitlement to payments.

When you haven’t utlised your WorkCover claim for a period of time and want to know what entitlements you may still have

If it’s been a while since you’ve claimed anything under your WorkCover claim, you might want to contact the insurer and ask what WorkCover entitlements you still have open to you.

How many weeks of weekly payments do you still have left to claim?

Has the insurer terminated your entitlement to any medical and like expenses and if so what?

Have you claimed an impairment benefit lump sum?

As previously mentioned, your WorkCover claim isn’t closed by default just because you haven’t utilised it for a while.

Even if a WorkCover insurer advises you that your claim has been ‘closed’, this might just mean the claim has been marked as closed on their system.

It doesn’t necessarily mean that you don’t have any entitlements open to you to still claim.

Once you have an accepted WorkCover claim, the claim does not just close – you either have exhausted an entitlement or not.

You can read more about this here.

When you’ve submitted a funding request to the insurer and want to know how things are progressing

If you’ve submitted a request to the insurer to approve and pay for something – say surgery or another type of medical and like expense for example – you can contact them at any stage and ask for an update in relation to the status of your request.

Sometimes, doing so can give things a push along and minimize any delay.

What is a reasonable amount of time to wait before contacting the insurer?

This depends upon the nature of the request.

If you’ve submitted a request for payment of a physiotherapy invoice, you would expect a week or thereabouts to be a sufficient amount of time.

If you’ve submitted a request for approval and payment of a surgical procedure that costs $50,000, then the insurer is likely to take a bit more time with that one.

Perhaps this may take a month or more.

They may in this instance want medical material from your treating surgeon. And/or they may want to have you medically assessed by an IME.

When you’ve lodged a claim and want to know how the claim determination process is progressing

When you’ve lodged an initial WorkCover claim, at any time you can contact the insurer and ask them to provide you with an update as to the status of the claim.

If you have gone through the IME assessment and the insurer isn’t waiting on anything further to determine the claim, yet you haven’t heard from them as to whether they’ve accepted or rejected the claim, you are able to contact the insurer and ask for an update.

When you want to know how your impairment claim is progressing

When you’ve lodged an impairment claim there can be quite a bit of waiting.

You can wait for the claim to be acknowledged by the insurer. Wait for the insurer to organize an independent medical examination. Wait for the outcome of the medical examination and notice of entitlement from the insurer.

At any time you can contact the insurer and ask for the status of the claim. How are things progressing.

What about the status of a common law claim?

If you have a common law claim on foot, you should in most instances not be contacting the insurer and asking about the status of that claim.

You should be contacting your lawyer (assuming you have one – which you should).

The insurer will have very little idea as to the status of a common law claim as it’s not something they personally handle.

For a broader explanation of how WorkCover claims work from start to finish, see How does WorkCover work?