Claims Service Provider support

How your Claims Service Provider can help and their limitations.

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Key takeaways

  • Your claims service provider is there to coordinate benefits, services and support for you during your claim.
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What your claims service provider can do for you

Your claims service provider is there to coordinate the many things you might need during a claim.

Here's a list of the many benefits you may be able to access when you have a claim:

  • weekly benefits to help offset your lost income when you can't work
  • the cost of reasonably necessary medical treatment
  • access to Occupational and Vocational rehabilitation services and support to help you return to work
  • reimbursement for expenses you incur while you have a claim, such as travel and parking
  • the cost of any medicines you need because of your injury
  • hospital costs if you need an inpatient stay related to your workplace injury
  • ambulance services
  • reimbursement for personal property damaged when you were injured
  • interpreter services
  • permanent impairment benefits if your injury is significant and long lasting. 

Your claims service provider will also be able to help you understand the limitations for each of the different types of benefits.

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What your claims service provider can't do for you

There are a few things your claims service provider isn't able to help you with, even though it might seem like they should, because it sits outside their area of responsibility. This is due to the underlying legislation that governs workers compensation.

The legislation sets out how workers compensation works in each state or territory, including what benefits and services a worker is entitled to receive when they're injured. There are also some limitations that affect the benefits you might expect to receive as an injured worker, including:

  • your weekly benefits, which start at a maximum 95 per cent of your Pre-Injury Average Weekly Earnings (PIAWE) and step down as the claim progresses
  • how your PIAWE is calculated, which is prescribed in the legislation and in guidelines published by the State Insurance Regulatory Authority (SIRA)
  • superannuation, which isn't paid in addition to your weekly benefit payments
  • employment benefits, like annual leave, which the workers compensation legislation doesn't provide an entitlement for
  • limits to the amount or type of treatment you can receive
  • access to lump sum impairment, which is limited by thresholds
  • restrictions on your weekly benefits, which can cease when you retire or when the claim passes a certain age. 

For injured workers living with a mental health condition, it can be the lack of availability of certain services that can be an issue.

Sometimes an injured worker will feel like someone should be held accountable for causing their injury. Your claims service provider can't punish your employer for injuring you, that's not the purpose of the workers compensation scheme.

There is no mechanism under the law to enable this and your claims service provider has no power to act in this regard. But there are other ways to address perceived injustice in the workplace if your claim service provider can't help.  

Workplace-facilitated discussions, also known as mediation, are one of the tools available to help address perceived injustice. These discussions are facilitated by an independent party, an accredited rehabilitation provider.

They explore the circumstances that led to the claim with each of the parties independently, seeking to understand the nature of the problem before bringing the parties together to explore ways to resolve the situation.

When the conversation happens, it occurs in controlled circumstances, with a mediator who keeps the conversation neutral, and outcome driven. They're also there to make sure everyone is heard that everyone gets to say their piece, and that any agreements reached are formally recorded.

Sometimes resolution can be achieved by the parties talking together and agreeing on how they'll respond to the types of issues that caused the problem in future. Sometimes an employer will agree to implementing a different system of work that might prevent future injuries. In other instances, an apology and an acknowledgement of the effect of the injury are what's required.

Every case is unique, your circumstances relate to you and your employer. Not every issue can be resolved in this way, but it can be surprisingly effective in cases where the thing blocking your return to work and ability to move on is about relationships in the workplace.

If your circumstances relate to industrial relations issues in the workplace, then you may consider taking your matter to be heard in the Fair Work Commission.

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