Reasonable action to claim compensation 117-01010020

Action

Description

Lodging a claim with their employer or with a compensation payer

A person has received a workplace injury and has lodged a claim for compensation. This claim has not yet been accepted pending a medical exam. While waiting for their claim to be accepted the person lodges a claim for income support.

Continuing to receive medical and rehab support after losing their entitlement to weekly compensation

A person has left their employment because they have enrolled in full time study and has therefore lost their entitlement to periodic compensation. Their compensation payer still pays for their medical and rehabilitation costs to facilitate their recovery.

Starting legal proceedings by engaging the services of a solicitor

A person has not lodged a claim for compensation under their relevant public liability act yet, but has entered a relationship with a solicitor and intends to pursue legal action

Seeking legal advice on whether a claim could be successfully pursued

A person has sought advice from a solicitor to explore their options but has yet to lodge a claim.

Scenario

Explanation

There is no enforceable claim for compensation

If a customer is unable to work as a result of a pre-existing medical condition diagnosed before the compensable injury was sustained.

Or

Where a customer sustained injuries at work and was employed under a contract which included a clause excluding the employer’s liability for workplace injury.

A change in circumstances where the customer is no longer eligible to a part of their entitlement to compensation payments.

The customer is receiving employment income that includes regular periodic payments. The customer decides to cease employment upon reaching Age Pension age. The ongoing entitlement to periodic payments ceases on the same day employment ceased.

Or

If a customer receiving regular periodic payments, fails or refuses to participate in rehabilitation without a reasonable excuse, the customers entitlement to compensation may be suspended or cease.

When the time limit has exceeded for the customer to make a claim for compensation.

The customer sustained compensable injuries years prior and is now unable to work as a result. Because a claim was not lodged at the time of the injury or within the required timeframe, they are no longer eligible to claim

Where the customer is not able to take legal action.

A customer’s financial circumstances may include but is not limited to considerations associated with:

• the customers’ ability to pay legal costs
• the estimated claim costs will be unreasonably incurred by the customer
• the compensation claim has limited prospects of success

The injuries will not result in the customer or their partner suffering a loss of wages, salary, or earnings capacity.

The customer has retired and has submitted a claim for Age Pension, within the claim, they indicate a possible entitlement to compensation following injuries sustained at the supermarket.

The customer decides not pursue the claim because the claim costs will exceed the total compensation payment and no entitlement to lost wages exists.

There may be a significant factor of contributory negligence.

The customer sustained injuries while intoxicated in the workplace.

Or

The customer sustained injuries in a serious car accident driving to work because of the customer failing to wear a seat belt and excess speed.

Or

The customer sustains an injury while failing to wear proper safety equipment and not following the safety procedures causing serious harm to others.

The expectation of the compensation payer is unreasonable.

A Compensation Payer has found the person fit for light duties, but their treating doctor believes they are still totally incapacitated

Scenario

Example

Failure or refusal to take action to claim or obtain compensation without a valid reason

A customer does not make a claim for compensation for their workplace injury because at the time they were working for their family-owned business and are concerned about an increase to the business insurance premiums.

Withdrawal of a claim for compensation without a valid reason

A customer decides it is too difficult to comply with employer requests and withdraws their compensation claim.

A customer has a relationship breakdown with the employer and decides it will be easier to claim a payment from Services Australia and withdraws their compensation claim.

Refusal to accept a compensation payment

The customer refuses to accept a payment offered by the compensation payer for their compensation claim, because it will cancel or reduce their income support payment.

Failure to provide a medical certificate to the compensation payer or insurer

The customer is unable to work but has not lodged their most recent medical certificate without an acceptable reason.

Preference to receive payments from Services Australia in place of compensation

The customer has determined it is easier to claim a payment through Services Australia rather than going through the compensation claim process.