First seven days of a claim

Once you have lodged your workplace mental health claim, what happens next?

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Key takeaways

  • You will need to obtain a Certificate of Capacity from your Nominated Treating Doctor.
  • Your assigned case manager will contact you to discuss your injury and the likely course of action moving forward.
  • Your case manager will also reach out to your employer and Nominated Treating Doctor to discuss your injury.  

What the claims service providers will do

Once the claims service provider has set up your claim on their system, your claim will be assigned to a case manager who will contact you to introduce themselves and discuss your workplace injury.

The claims service provider will aim to contact you, your employer and your Nominated Treating Doctor within three business days.

Your case manager will want to understand what has happened at work that led to your injury, and what steps you have taken since. They may ask questions to understand:

  • how you are currently feeling and coping
  • how the injury occurred in the workplace
  • if you have seen your Nominated Treating Doctor
  • whether you have been issued with a Certificate of Capacity from your Nominated Treating Doctor
  • whether your Nominated Treating Doctor has made any referrals to other specialists – such as a psychologist
  • what support you may need in the coming weeks
  • whether you have had any contact with your employer
  • whether you have completed a claim form.

There may be other information that the claims service provider will request that you collect and provide. For example, wage information such as your payslips and any other information that you believe will support your claim.

Tip: Keep your claim number on hand. The claims service provider will ask you for this at the start of each call, and your treatment providers will need to know your claim number so they can accurately invoice the claims service provider for your treatment expenses.

Your case manager will also make contact with the other stakeholders on the claim to gain further information around your injury and your recovery plan.  This may involve speaking to your employer and your treatment team (such as your Nominated Treating Doctor and your psychologist).

With these contacts, the claims service provider  is seeking information around:

  • the cause of your injury – what happened in the workplace that led to your injury
  • the provisional diagnosis
  • what treatment has been recommended or commenced
  • your current capacity for work and functioning in day-to-day life
  • whether you can return to work with your employer
  • whether there are any restrictions that need to be considered for your return to work
  • whether there are any return-to-work options available to assist with your recovery, such as a gradual return to work on reduced hours and reduced workload
  • what support you may need to facilitate your recovery.

Case managers understand that some Nominated Treating Doctors are extremely busy, and will   send a questionnaire to your Nominated Treating Doctor or specialist, so they can respond in writing at a more convenient time.

In summary, your case manager will be gathering information from yourself, your employer and your treatment team to establish that:

  • you are a worker covered by the employer's workers compensation policy
  • you sustained an injury in the course of employment
  • you have lost income and/or require medical treatment due to your injury.
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Your employer's requirements

Once your employer has become aware of your intention to lodge a claim, they have 48 hours to notify the claim service provider.

Once completed, the employer will be working to provide the claim service provider with the necessary information to move your claim forward.  For example, employers will be asked to provide the claims service provider with:

  • wage information including any payslips that reflect your earnings (to calculate your Pre-Injury Average Weekly Entitlement)
  • any certificates of capacity or medical information received from yourself
  • any invoices received from your medical appointments
  • a copy of your claim form
  • information about your pre-injury role and any alternative work that may be available if you are unable to resume your full duties.
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