For a Comcare claim to be accepted, claimants must show that they are a ‘worker’ as defined in the Safety, Rehabilitation and Compensation Act 1988 (“SRC Act”) and that they have suffered a ‘injury or disease’ as defined in the SRC Act. Applicants must also be able to prove that their employment contributed by a significant degree to their injury or disease, and that their injury or disease is not excluded under the SRC Act because, primarily, it was caused by the reasonable administrative action of the employer.
What goes on the claim form and evidence in support of the claim becomes the basis for the investigation of the claim by Comcare. This information can mean the difference between acceptance and rejection of the claim. We urge members to seek advice from the AFPA prior to lodging any claim for workers compensation.
The AFPA can assist members with submitting statements and advising on what evidence will be needed to support the claim. Comcare will not make claimants aware of their right to seek advice, nor will they necessarily advise that claimants have the right of reply to the information they gather. These aspects are critical in all claims and if members involve the AFPA from the outset of the claim, the appropriate advice can be given to significantly increase the chances of claims being accepted.
Once an injury occurs, it is important that members consider the following:
- Notify your employer of the injury and complete an incident report as soon as possible – Comcare will need to verify the injury and if there has been no report logged, it will make it more difficult to prove. Claimants should demonstrate that they have discharged their obligations in reporting incidents and have abided by any relevant processes in the workplace to support their claim.
- Always check the paperwork – It is necessary to obtain a medical certificate from an appropriately qualified medical practitioner when submitting a claim. Ensure the diagnosed medical condition and its cause are recorded correctly on each certificate received.
- Always respond to Comcare’s requests in writing – This can be done by email. Comcare actively encourage all claims activity by phone, saying this makes the scheme ‘more accessible’ to workers. However, they record what is said as file notes in their words, rather than the claimant’s. It is far better to have the context of these comments recorded in a controlled way in writing.
- Be specific about the event – In reporting the cause of the injury, ensure your focus is on the event or incident that caused it. For example, if the injury was caused when walking from one place to another, be sure to outline the exact nature of the activity you were undertaking. E.g., if you are walking from the armoury to the vehicle, ensure a link is made between the injury and the employment.
- The burden of proof – The onus of proof of injury always rests with the worker. For physical injury claims, this means that the claimant needs to be able to provide enough proof that the injury occurred as a result of their employment. For psychological claims, the same needs to be proved as well as, generally, that the psychological injury was not caused by the reasonable administrative action of the employer. If an injury was caused by the reasonable administrative action of the employer, unless the claimant can prove otherwise, the claim will be rejected even if an injury has been suffered. Supporting documents should be offered, such as incident reports and names of any witnesses to the event provided.
- Natural justice – If Comcare obtains information from other witnesses or the employer that impacts detrimentally on your claim, claimants are entitled to a copy of that information as well as the opportunity to respond prior to a decision being made on the claim
If you require assistance in preparing a Comcare claim, please do not hesitate to get in touch with the Team at afpa@afpa.org.au or on (02) 6285 1677.