Making a Comcare ClaimEverything you need to know

OVERVIEW

Introduction

What kinds of injuries does Comcare cover?

What will I be compensated for?

Four steps to a Comcare claim

What if Comcare denies all or part of my claim?

What if the injury or illness was caused by my employer’s negligence?

Another insurance alternative

A word to employers

Get the Help From Us

INTRODUCTION

If you have been injured at work and are a Commonwealth employee or an employee of a corporation that has been granted a license to self- insure, such as Telstra or Australia Post, you may be able to make a Comcare claim. The rights of this subset of full-time, part-time and casual employees are specially covered by the Safety, Rehabilitation & Compensation Act 1988.

Like other workers compensation claims, a Comcare claim does not require any showing of fault or negligence. If you choose to make a Comcare claim, however, you will waive your right to sue at common law, so the decision requires deliberate thought. In some situations, employees may also be entitled to permanent and total disablement insurance payments.

WHAT KINDS OF INJURIES DOES COMCARE COVER

The injuries for which employees may receive compensation include

- physical injuries

- psychological injuries

- the worsening of preexisting conditions because of workplace events or conditions.

When coverage disputes arise, they often focus on the question of causation, or whether an injury or illness arose from employment or an outside cause.

WHAT WILL I BE COMPENSATED FOR

If an employer accepts liability, Comcare may cover medical and rehabilitation expenses such as doctors’ appointments, surgeries, physiotherapy and chiropractic care.

Injured workers may also receive payments for lost income at 100 percent for the

first 45 weeks. Thereafter, the rate drops to 75 percent of income if the employee is totally incapacitated.

If an employee is left with a permanent impairment as a result of any physical or psycho-logical injury, he or she may also be entitled to a single lump sum payment which does not impact income payments or reimbursement for medical expenses.

FOUR STEPS TO A COMCARE CLAIM

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If you have been injured or developed an illness that you believe is employment-related, you should report it to a supervisor as soon as possible, whether you intend to make a claim for or not.

Anyone who has been injured should consult a medical provider and ask for a medical certificate that gives a precise diagnosis of the condition for which compensation is claimed, including cause, date of injury, fitness for work, recommended treatment and other details.

Although employers sometimes recommend a company doctor, workers should know that they may seek medical treatment from any doctor, including their own GP. Employers may also ask employees to sign docu-mentation authorising them to deal directly with the doctors and even to be present during medical consultations. Employees need not give permission and should consider seeking legal advice before they do.

It is important to keep detailed records and notes of the claim and the circumstances of the injury or illness, as well as any medical costs incurred.

With medical certificate in hand, the next step is to com-plete the Comcare claim form. Many find it complex, and benefit from assistance from Comcare or an attorney.

The claim for compensation should be lodged with the employer for whom you worked when you were injured or became ill. If that employer no longer exists, you may lodge the form with Comcare, itself.

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WHAT IF COMCARE DENIES ALL OR PART OF MY CLAIM

If you are dissatisfied with a determination, you may request reconsideration by an independent review officer, but there are strict time limits for filing an appeal.

A request for reconsideration, setting out the reasons that you believe the initial decision is in error, must be made within thirty days of receipt.

If you disagree with the reconsidered decision, further levels of tribunal review are possible, but requests must be made within 60 days of the subsequent decision. In some limited circumstances, the tribunal decision may be appealed to the Federal Court.

WHAT IF THE INJURY OR ILLNESS WAS CAUSED BY MY EMPLOYER’S NEGLIGENCE

As an alternative to a Comcare claim, you may be able to claim common law damages if your injury was caused by the negligence of your employer and your level of permanent impairment is at least 10 percent. There may be limits on the size of the possible award, especially any portion due to pain and suffering

Any claim for damages must be made within three years of the date of injury. Once an election is made to accept lump sum compensation or pursue common law damages, the decision cannot be changed. If you believe that negligence was an issue, you should obtain legal advice before making any decision.

ANOTHER INSURANCE ALTERNATIVEIf your claim is denied, even after reconsideration or your common law suit is not successful, you may still be able to make an insurance claim for total and permanent disablement.

Sometimes this insurance is available through a superannuation fund or it may be “hidden” as part of another financial instrument, such as a home mortgage.

A WORD TO EMPLOYERS

Employers should make sure that employees know to give notice of workplace injuries and submit completed Comcare claims as soon as possible.

Part of this task involves developing procedures that are readily accessible, displaying the name of the case manager and encouraging injured workers to seek a medical diagnosis that will determine whether the injury or illness is workplace-related.

Because workers compensation schemes, like Comcare, are not adversarial relationships based on a finding of fault, employers and employees have an incentive to work together to ensure that the system functions collaboratively.

GET THE HELP FROM US

At Owen Hodge Lawyers, we would be happy to assist employees in filing Comcare claims or in the difficult situation where claims are denied. We are also happy to provide employers with the guidance they need to comply with their obligations toward Comcare-covered employees. We look forward to speaking with you.

Please call at 1800 770 780 or contact us via ohl@owenhodge.com.au to schedule a free consultation.

1800 770 780

ohl@owenhodge.com.au