Reasons for Denial of Workers Compensation Claim

June 25, 2024    Personal Injury Lawyers Perth
Reasons for Denial of Workers Compensation Claim

Accidents indeed don’t occur with prior notice and can happen anytime and anywhere. It is also true for workplaces and in Australian regulations, workers are eligible to receive payment through insurance companies if they suffer from any injury in the workplace or fall sick for work-related reasons.

However, it is not easy to claim workplace insurance if you don’t know the nuances related to it. Sometimes, such claims can get denied, provided the proper steps are not followed. In this article, we discussed the most crucial reasons for the denial of worker’s compensation claims that even the best personal injury lawyers Perth will help you with.

Knowing section 78

Companies can deny compensation claims to employees, and workers have the right to contest them. The most successful workers’ compensation lawyer, Perth, has high success rates in overturning these denials. So, their clients don’t have to pay for anything out of their pocket.

The insurer can question your worker’s compensation claim – most of them question it before accepting. However, if they deny the applicant’s claim, they must issue the worker a decision notice or Section 78 notice. This letter will outline reasons for denying your claim but needn’t mention that it’s a Section 78 claim.

The Section 78 letter must include the following –

  • A list of all documents available to the insurer when it has made its decision (including copies of those you don’t have).
  • A clear statement explaining why the insurer has been uncertain about the liabilities and the factors that brought it to that decision.

Comprehensive guidelines for the ways you can request a decision review.

Our legal advisors have worked in thousands of workers’ compensation claim denial cases and can offer directed and practical advice.

Reasons why workers’ compensation claims are denied

When the petitions are denied, the workers can face several hardships. Despite the good faith of the involved parties, sometimes things do not work out. In such situations, it is important to consult a legal advisor. In this section, we will explore a few reasons why claims are denied.

1. Inadequate evidence

One of the primary reasons workers comp claim denied is because of this. If an injured employee cannot provide the necessary proof of an accident, then they cannot win the claim. This becomes especially true when there are no witnesses or medical records of the incident. In such scenarios, the worker is forced to pay out of their pocket until the dispute is resolved. Therefore, it is essential to keep all the relevant proofs unless the dispute is resolved.

2. Erroneous process

Besides inadequate evidence, if the process of application is faulty, then the authority can deny the workers claim compensation. The Australian government has set strict rules that need to be abided by when the victim is filing for compensation. Thus, a small mistake can result in immediate rejection. To ensure that you do not face such issues, you can hire a legal advisor who will guide you through each step. This will ensure a smooth claim settlement as the vital paperwork will be handled by a qualified workers’ compensation Lawyer in Perth.

3. Delaying medical care

If you have faced an accident during working hours, it is advisable that you seek immediate medical care. Please do this to avoid the denial of your workers’ compensation claim. Moreover, not only does the certificate prove the incident, but it also shows the cause and extent of the injury. With a medical report, it is easier for you to prove that the injury was sustained during work.

4. Not paying heed to the employment policy

Most policies state the safety guidelines that you need to follow at work. However, if you fail to abide by them, it may lead to a denial of the compensation claim. In such scenarios, the employer can argue that the injury was your fault.
You had a pre-existing injury

Insurance companies can deny your petition if you have some pre-existing conditions. According to law, workers’ compensation covers only the injuries or illnesses that were caused during working hours or due to the work environment. Sometimes, if the pre-existing conditions aggravate due to work pressure, you may receive the claims.
It is important to note that this is a partial list. We have addressed only a few reasons why such compensations are denied.


The workers are assured of their salaries during their recuperation period, along with any medical expenses and rehabilitation costs through the worker’s compensation. These rules, mandated by Australian law, serve as a safety net for workers and employers. However, the guidelines and conditions differ according to state. So, it’s best to consult the most experienced legal advisors for any worker’s compensation claim denial cases, ensuring your rights are protected.

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