My workers compensation claim to Comcare/EML was denied, what can I do now?

Health Law, Litigation & Dispute Resolution

Have you submitted a claim for workers compensation with Comcare or EML, and they have come back denying that they are responsible for your injury? Are you wondering what the next step is? Our article will discuss what next step is available and will give you some of our most common tips as you navigate these next stages in the claims process.

What is the next step?

You are able to request a reconsideration of Comcare or EML’s decision. This request should be made in writing and have your arguments for why the initial decision is wrong. Our tips for preparing this request are:

Identify the issues Comcare or EML have raised, and address these, and only these, in your reconsideration – this is really important as failing to address the key issues may impact your chances of changing Comcare or EML’s first decision.
Stick to the facts – try to avoid emotive statements and opinions. It is best to point to the facts, such as any medical opinions and evidence about what you felt, saw, heard and experienced.
Use headings – this helps make sure you are staying on track with your arguments. It will also help signpost for the reader.
Be brief – there is power in concise and clear submissions.

Your request for reconsideration must be made within 30 days after you received Comcare or EML’s decision. It may not always be possible to make this request within 30 days, so it may be necessary to request an extension. For example, you may be waiting for further information from a treater. You should write to Comcare or EML and outline why you need an extension before the time expires. It is up to Comcare or EML as to whether they agree to this extension, so do not assume that you have been given an extension. Make sure you get confirmation that it has been.

What happens after your request for reconsideration is submitted?

Your request, as well as all the other documents already on your claim file, will be given to a Reconsideration Officer for review. This Reconsideration Officer is independent from any previous management of your claim. This means that they were not involved in the initial decision-making process. They will be looking at the matter afresh. Your employer may be given an opportunity to provide any further information.

The relevant law requires Comcare or EML to decide a request for reconsideration made by you within 30 days of the request being made. You will be notified in writing of Comcare or EML’s decision. This decision is called a reviewable decision.

If you continue to disagree with Comcare or EML’s reviewable decision, you may request this be reviewed at the Administrative Review Tribunal. This must be done within 60 days of receiving the reviewable decision.

Need our assistance?

A reconsideration can be a really important step in the claims process. A well-prepared request could be the difference between Comcare or EML changing their decision. It could also impact any arguments you could make before the Administrative Reviews Tribunal.

At elringtons, we specialise in Comcare and EML claim, helping workers across all stages of the claims process. We would be more than happy to discuss your matter with you and assist with your reconsideration request. Feel free to contact us if you would like to discuss your workers compensation matter and next steps.