Your worker has lodged a claim for a mental injury. What's next?

Finding out your worker is making a Work Cover claim for a mental health related injury can be challenging.

This video explains how you'll be part of the claim, what your role is and what to expect.

We'll also cover how Work Cover makes a claim decision and what we might ask of you.

Every claim is different, but all claims need to meet certain criteria to be accepted at the start.

Work Cover will look at the information we have and figure out if there are any gaps.

Next, we'll talk to your worker and sometimes their doctor to understand what caused their mental injury.

Then we'll give you a summary of the claim.

We'll ask you to respond and outline what information we need from you as their employer.

We'll usually ask you questions about your workers role and events that may have led to their mental injury.

We might also ask for relevant policy and procedure documents from your workplace.

We'll give you a time frame to provide your response, usually a few days.

It's important to stick to this time frame because legislation says we need to decide claims within 20 business days.

Sometimes there's a dispute about the circumstances around the claim or what caused your workers injury.

When this happens, it's important to be objective in your response and stick to the facts.

That's because work cover makes decisions based on the evidence.

Keep in mind, your worker will also see your response when we send it to them and ask if they want to provide further information.

We do this so that there's procedural fairness, also known as natural justice.

We'll do the same for you until we can decide if the claim is accepted.
Whatever happens, we'll let both you and your worker know about the claim decision and keep you updated along the way.

Not all claims are accepted.

Work Cover looks at every claim to decide if it fits into the rules and guidelines.

This means we can't accept claims if medical information shows the worker doesn't have an injury, even though they might feel stressed.

A doctor has said that work is not a significant contributing factor to the injury.

There is not enough information to support a worker's version of events.

There is a time limit for making a claim too, usually six months from when they first saw a doctor for the injury.

A worker is also not eligible for compensation if their injury was caused by management action if it was reasonable and carried out in a reasonable way.

This might be performance or discipline related, or include things like team changes, leave approvals or promotions.

If we accept the claim and you disagree, you can ask us to give you written reasons for our decision within 20 business days.

If you still disagree, you can ask for the decision to be reviewed independently.

Find out more by searching for independent review of insurer decisions on our website.

Work cover pays for workers to receive treatment for a mental injury before the claim is decided.

This might include sessions with a psychologist, psychiatrist or GP.

This is because recovery can start sooner when workers can access treatment early and they can get support during the decision process.

If the claim is denied, work cover won't continue to pay for the workers psychological treatment.

The worker doesn't have to pay these costs back and it won't affect your premium calculation either.

Remember, one of the most important things you can do for a worker with a mental injury is to check in to see how they're doing and if they need any support.

If there's something you're not sure about, you can give us a call.

We're here to help.

Find the details of your claim contact by logging into Work Cover Connect, our online services portal or call 1-3 hundred 362128.

If you need help in your language, call 1800 512 451 and ask for an interpreter.