Workers compensation claims management
Managing your WorkCover Claims
At Cubela & Co, we know what good workers compensation claims management looks like. We will provide every assistance to you and your claims agent to influence and promote accurate, appropriate, timely and sustainable claim decisions; effective injured worker, employer and stakeholder engagement; and the reduction of disputes, litigation and work injury insurance costs.
We understand that each employer, workplace, worker, injury and claim is unique and there is no such thing as a “one size fits all” approach. Whilst a full and comprehensive initial liability and claim review might not be required on all occasions, efficient and effective injury and workers compensation claims management throughout the process can benefit everyone at every stage.
Our bespoke service offering provides just a snap-shot of what we can do for you:
Initial claim reviews
- Injury notification and claim timing.
- Legislative compliance – avoidance of breaches, penalties and litigation relating to injury notification, discrimination, return to work, claim receipt and forwarding.
- Accuracy of injury and claim registration.
- Claim validity review.
Injury circumstances – information gathering and witness availability for optimal claim investigation, circumstance investigator selection and management, legally available searches, independent medical examination selection and request input, treating health practitioner identification and information requests.
- Eligibility review – full consideration of employment and injury circumstances and the applicable legal tests for acceptance or rejection of liability or non-entitlement to payment of compensation for example, worker or deemed worker, State of connection, work-related injuries, deemed injuries, hearing loss claims, exclusions to compensation entitlements, reduced payments and out of jurisdiction claims.
- Legal submissions regarding claim liability.
- Self-insurer claim and circumstances review and notice writing.
Post initial claim acceptance
- Legal submissions for objection to, or review of, claim acceptance.
- Third party recovery potential to reduce claims costs and premium.
- Pre-injury earning assessments for accurate income replacement calculations – normal hours and weekly earnings, overtime and shift allowances, earnings enhancements and exclusions, leave impacts, make-up pay.
- Exclusions to payment of claim excess.
- Excess management – gratuitous services, occupational rehabilitation services, medical treatment.
- Income replacement – when and what to pay, employer reimbursement, avoiding interest and penalties.
- Promoting appropriate and sustainable reduction, termination, cessation and determination or non-payment of compensation determinations in accordance with law, including notice drafting and reviews.
Return to work
- Employer obligations commencement and relevant period calculation – inclusions and exclusions.
- Return to work coordination – let us manage your return to work program and claims.
- Employer and labour hirer legal obligations to reasonably return injured workers to work.
- Treating health practitioner consultation and case conference attendance.
- Stakeholder liaison and management in the return to work process – workers, unions, nominated and legal representatives and service providers.
- Workforce information, management and occupational health and safety obligations.
- Effective return to work planning and suitable and pre-injury employment provision.
- Occupational rehabilitation services enhancements and alternatives – training, functional assessments, work capability interviews.
- Worker obligations and enforcing compliance and legislative sanctions.
- Regulator engagement, compliance and penalty avoidance.
- Employment separation solutions.
Ongoing claims management
- Claim file review attendance to drive effective claim strategy and costs containment.
- Income replacement entitlement reductions – step-downs, enhancement inclusion periods, pensions, disability and lump sum payment impacts, return to work.
- Superannuation contribution entitlements.
- Medical and like services – reasonable costs and eligibility requirements.
- Impairment and lump sum benefit liability and entitlement assessments.
Work capacity improvement – suitable employment options, vocational re-education and training, occupational rehabilitation services monitoring.
- Compensation entitlement reviews – surveillance, independent medical examinations, treatment and information updates, case management strategy, legislative breaches and fraud.
- Suspension, non-payment, non-increase, non-entitlement, termination and cessation and determination of income replacement entitlements and medical and like services – how to initiate, enhance and enforce quality decision making.
- Information gathering – claim form authorisations, enforcing worker and third party information requests under legislation and court processes, Freedom of Information Act requests, worker access to information.
- Legislative compliance – avoidance of breaches regarding compensation payments, return to work and discrimination, penalties, increased claims costs from interest and litigation.
Complaints, disputes and litigation
- Managing and responding to worker, union, family and legal representative grievances.
- Employer complaints – who to complain to and when, escalation points, legal submissions, legislation review rights, other avenues of redress and enforcement of legal rights.
- Dispute management – conciliation and mediation preparation and attendance, legal submissions and review and enhancement of Medical Panel referral documentation (where applicable).
full dispute and litigation service for self-insurers, court representation, briefing of counsel etc.
panel firm lawyer liaison, defence and litigation preparation, document and evidence enhancement, responding to lawyer information requests and subpoenas, witness preparation, court and tribunal attendance and input.
IF YOUR BUSINESS HAS RECEIVED A WORKCOVER CLAIM,
YOU NEED TO SPEAK TO RACHEL ON 0452 248 276.
Legal consultation for employers & self-insurers