If you are unhappy with a determination or decision made on your claim you are entitled to challenge it.
The decisions you can challenge include:
- the rejection of your claim - whatever the reason
- the reduction or discontinuance of your weekly payments
- lump sum payments for permanent disability
- payment of medical or other expenses
- average weekly earnings
- some matters relating to rehabilitation
- death benefits for dependants.
WorkCover continues to provide advice to injured workers and employers on entitlements, claim decisions, disputes and scheme navigation. Call our Service Centre on 8233 2463 for free, confidential advice.
If the issue is not resolved, you may wish to register a formal complaint with WorkCover. You can use this website to contact us to make a complaint.
If your complaint relates to a rejected claim you can also lodge a notice of dispute with the Workers Compensation Tribunal.
The delivery of advocacy and representation services on behalf of injured workers is now being provided by SA Unions and Business SA. Advocacy services for claimants who are in dispute with WorkCover are provided by individual unions for their members. Non-union members may also seek legal advice or representation from lawyers or SA Unions and Business SA.
Example: Rejected claim
Sophie develops an illness that she feels is related to her work. She visits her GP and receives a Prescribed Medical Certificate, and then lodges a claim for compensation. After 15 days, she hears that her claim has been rejected. What can Sophie do?
Sophie should firstly discuss the claim with the claims agent to discover why the claim was not accepted. If she is unhappy with the decision and wants to pursue it, she is entitled to lodge a Notice of Dispute with the Workers Compensation Tribunal within one month of receiving the decision. The decision will be internally reviewed by the claims agent.
If the decision is not changed, she can pursue the dispute through conciliation firstly, then arbitration and finally judicial determination if necessary. Sophie can seek assistance and representation from her union or a solicitor.
WorkCover Ombudsman
If you have a problem relating to the operation of the WorkCover Scheme, you can contact the WorkCover Ombudsman, who runs an independent office set up to investigate complaints. The Ombudsman can implement the 'safety net' for injured workers, testing the reasonableness of decisions to stop weekly payments. To contact the Office of the WorkCover Ombudsman please phone (08) 8463 6593, email owo@saugov.sa.gov.au or www.wcombudsmansa.com.au.
Download 'WorkCover Ombudsman' fact sheet
For more information see our fact sheet Help when you’re not satisfied - A guide to workers compensation disputes.