Frequently asked questions

Common questions employers have about mental health claims.

If you don't see an answer you're looking for, please let us know via the Did you find what you were looking for? section at the bottom of this page.

If your request is urgent, please reach out to your Claims Service Provider.


  • How is alleged bullying and harassment considered in the liability process?

    The circumstances surrounding bullying and harassment can be contested and it is often necessary to engage an impartial third party to conduct a factual investigation.

    Factual investigators will take statements from individuals who have been involved in the situation to better understand what has taken place.

    The case manager will consider this information amongst other evidence when considering liability for the claim. The case manager will often share a summary of the investigation with the worker's treating doctor or an independent medical examiner to better inform their opinion about causation for the injury. 

  • How to differentiate between "stress" (or other acute emotional responses) and a diagnosable psychological injury?

    Stress itself is not a diagnosable injury, however, exposure to excessive and long-lasting stress can lead to a mental health condition.

    It's important to remember that each individual will respond to and interpret stress in their own unique ways. Some individuals will have coping mechanisms whilst others may not feel equipped to manage the stress in their life.

    The worker's doctor is likely to make an initial provisional diagnosis in their first consult, before seeking further guidance from a psychologist or a psychiatrist.

    The doctor, psychologist or psychiatrist will complete a psychological evaluation where they ask questions about mood, thoughts, and behaviours, sometimes by using questionnaires or forms.

    If the information provided by the workers treatment team is unavailable or incomplete, the Claims Service Provider can refer to an independent medical examiner for their expert opinion on diagnosis. 

  • How to proceed with claims that are a result of performance management, but the worker is also alleging bullying as a result of the process?

    It's not uncommon for an injured worker to perceive that performance management is bullying or harassment. This does not mean that it is, but it is understandable that perception exists. Certainly, workers can develop diagnosable mental health conditions in response to the performance management process.

    For a Section 11A defence to be available, a worker must first have a diagnosable mental health condition and the employer's actions must have been reasonable as they have carried out one of the nominated activities under Section 11A (for example, performance management).

    If these conditions are met, it is possible to defend the claim under Section 11A despite the allegations of bullying and harassment and the diagnosed mental health condition that results.

    If bullying and harassment has alleged to have occurred outside the performance management process and can be verified through a factual investigation, then a Section 11A defence is likely to be unavailable and the claim may be accepted. 

    Medical and treatment

  • How do we treat a claim when a worker is known to already have a mental health condition?

    Workers compensation legislation allows for circumstances where a pre-existing mental health condition is exacerbated by events in the workplace.

    During initial investigations, your case manager will be asking treating practitioners and/or independent medical examiners to make an assessment about what has caused the worker's current condition and will assess whether employment was the substantial contributing factor to the injury.

    During later stages of the claim, case managers will seek to understand from treating practitioners and/or independent medical examiners whether the aggravation to that pre-existing medical condition continues or has ceased and will make a liability decision on the claim accordingly.

  • How do we proceed when a worker is not participating in the workers compensation process

    Where possible, we should try to understand why they may not be participating in the process. For example, some workers may feel more comfortable having a support present during calls or meeting, others may feel that at this moment in time, their current symptoms are too overwhelming for them to have conversations about return to work.

    Once we understand the worker's reasoning, we will be better equipped to address the barriers.

    How to support your worker

  • As an employer, how do we manage a workers compensation claim when a worker has requested no contact or feels triggered by contact from the workplace?

    It is a feature of some mental health conditions that interaction with workplace and colleagues can be a triggering experience. It's important for stakeholders to be flexible when this situation arises.

    There are often alternative ways to engage with a worker who is struggling with direct contact.

    For example, the case manager can devise a communications plan with the worker that uses strategies other than direct contact (for example, email or third party), or create a schedule for contact so the worker can control the feelings they experience and plan when and how they will engage. This often helps them to minimise the stress associated with these contacts. 

  • What occurs on a claim when a worker is not responding to their treatment plan?

    The worker's wider treatment team including their nominated treating doctor, psychologist and sometimes psychiatrist, may also consult as a team and discuss treatment options. Where this option is unavailable or unproductive, there are other paths available.

    There are a number of options available to assist the Claims Service Provider and treating doctor when treatment is not progressing as expected.

    The Claims Service Provider may consider a referral to an independent specialist who will give their opinion about alternative paths for treatment. These include independent psychological consultants and independent medical examiners.

    It's worth remembering here that each individual will experience different benefits with different types of treatment.

  • What happens when a worker with a physical injury develops mental health symptoms?

    It is possible for someone to develop a secondary or consequential condition that arises as a result of the circumstances of the injury or the management of the claim.

    The types of things that may cause a secondary injury include:

    • chronic pain conditions
    • disconnection from the workplace
    • conflict during the claims management process
    • loss of function
    • impact on family and relationships.

    When it becomes apparent that a secondary or consequential condition might have occurred, the case manager will need to investigate further and make a decision whether or not that condition relates to and can be managed as part of the claim. This is effectively an additional liability decision for the claim.

    In making this decision, the case manager will need to consult with the workers treating doctor, psychologist, and/or an independent medical examiner.  

    Return to work

  • When is the best or most appropriate time to change the return to work goal from same employer to new employer?

    As soon as it becomes apparent to the stakeholders on the claim that a return to work with the same employer is unlikely.

    These decisions are usually made in consultation with the worker, their employer and their treatment team. If the parties agree that a change in return to work goal is appropriate, then the case manager can then focus on the new employer return to work goal and initiate the steps necessary to move down this path.

    There is no specific point in the claim where this decision must be made, rather, it is something that the parties need to recognise and agree. The sooner this can occur, the sooner the claim can continue to move towards resolution.

    The Claims Service Provider can take over wage payments to the worker when the return to work goal has been confirmed as new employer.

Tagged in: