How to manage disputing a claim
| 1. | Speak with the insurer and get their input and buy in to assessing the claim |
| ▪ | Get clear on the date the information is needed to be sent to an assessing doctor |
| ▪ | Ensure any third party eg. an investigator, is qualified and has a quality reputation |
| 2. | Ensure you are present for the discussion with the investigator and they are clear about the issues. Having the investigator cover the chronological history of events, but not provide details of the job may be appropriate in one case, but it may miss the key issues in another. Have relevant people available for the assessment and make sure the investigator is provided with any documentation such as leave forms, job worksheets etc. |
| 3. | Ensure relevant information is sent to an assessing independent doctor. |
| 4. | Write a letter to the doctor yourself outlining the issues. |
| 5. | Request the assessing doctor come to the work-site to review the duties where relevant. |
| 6. | Communicate with the employee about the process. Let them know the case being assessed, be open and straight about the process. Let them know about the relevant dates, such as when a decision will be made. Advise them of pay alternatives, e.g. sick or annual leave that can be taken while the case is assessed. |
| 7. | Foster return to work from the start; don't wait until a decision is made. If a claim is not accepted, the employee may use the dispute resolution system resulting in the claim being accepted at a later stage. This may be months down the track and too late to resurrect return to work as an option. |
| 8. | Don't dispute cases without justification; it will damage your reputation for future cases. |
| 9. | Ensure supervisors and co-workers do not prejudge the injured worker. They need to be fully aware that it is the decision of the claims agent/insurer to determine liability, not the employer. |
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