How to make a claim

You can make claim on the phone or you can use this form (Return To Work SA Claim Form) from the Return to Work SA website.  Lodge the claim and the insurer has 13 weeks to investigate the claim. If it takes longer than 13 weeks there are legal ways of making the insurer complete their investigations and we suggest you contact us if this applies to you.

What happens if my claim is rejected

 If the claim is rejected you will have 28 days to dispute the determination made by the Insurer (EML or Gallagher Bassett) in the South Australian Employment Tribunal (SAET). We can assist you in filling out the the required forms and paperwork for the tribunal.

Disputes

A rejected claim is not the only dispute you could have.  There could be issues with the way your income or duties were calculated or the insurer may be refusing to pay for some treatments.  All these issues can be dealt with in the Tribunal.

Conciliation Process

If a dispute occurs you will go through a conciliation process. This matter should remain at this level of the Tribunal before a Commissioner for approximately 13 weeks but this can vary. This is an opportunity for you and the insurer and potentially your employer to resolve the matter without going to Court.  It can also be a way to settle an outcome, get further information such as doctor reports and outline all the issues the parties have. If a result cannot be negotiated through this process then you pursue the matter to Hearing and Determination which is the Court process, where a Judge will manage the process. We will guide you through every step of the process.

Entitlements

Workers Compensation has a number of entitlements you may not be aware of:

• Income maintenance – this can only commence when you lose time from work and there are restrictions for how long you will be entitled to wages
• Medical expenses – there are restrictions on how long you will receive this
• Permanent impairment entitlements – if your injuries are permanent
• Rehabilitation costs, training and other aids you may need
• Travel costs to and from medical appointments

These are all things you may be entitled to and not know about.  You should contact us to discuss where we can help you. Each case is different and that’s why it’s important to discuss with a lawyer all the issues before you make a decision on how you proceed. Disputes with the Tribunal the Insurers/Return to Work SA will contribute an amount to your legal fees and we will discuss this with you and make it clear for you to understand.

Comcare

If you work for a national employer and are injured, you may have similar entitlements under the Comcare scheme and your matter will be handled differently through the Administrative Appeals Tribunal.  It is a different process and claims will need to be made to either the employer or through the Comcare website  https://forms.comcare.gov.au/. The process is different in that the Employer and/or Comcare can investigate the claim and make a determination. You then have a limited time to respond and seek an appeal of that decision internally and if you are not happy with that reconsideration you have 60 days to lodge a dispute in the Administative Appeals Tribunal. Costs differ in this jurisdiction and again we will discuss this with you.