Making successful psychological injury claims

How To Make A Successful Psychological Injury Claim

Psychological or psychiatric injuries may include work related stress, post traumatic stress disorder, anxiety, depression, or other mental illness.

To receive compensation (to cover medical expenses and more) for these types of psychological injuries, the injury must have occurred at work and resulted from a single event or over a period of time.

Examples of causes may include workplace bullying, harassment, unfair action taken by management or an excessive workload. Psychological injuries arising from these causes may make a person eligible to make workers compensation claims.

Workers' Compensation & Rehabilitation Act 2003

For a worker to have their psychological or psychiatric injury accepted as an “injury” compensable under the Workers Compensation & Rehabilitation Act 2003, the work event, or exposure over a period of time in the workplace, must be the major contributing factor to the psychological or psychiatric injury occurring.

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How Workcover or the self insurer decide your claim

When making a decision on a claim for psychological injury, the workers’ compensation insurer will apply criteria and exclusions as outlined in the Workers’ Compensation and Rehabilitation Act 2003.

The Act states that ‘an injury does not include a psychiatric or psychological disorder arising out of, or in the course of, any of the following circumstances’:

  • Reasonable management action taken in a reasonable way by the employer in connection with a worker’s employment

  • A worker’s expectation or perception of reasonable management action being taken against a worker

  • Action by the authority or an insurer in connection with a worker’s application for compensation.

Examples of actions that may be reasonable management actions taken in a reasonable way include:

  • action taken to transfer, demote, discipline, redeploy, retrench or dismiss a worker

  • a decision not to award or provide promotion, reclassification (or transfer of), leave of absence or benefit in connection with the worker’s employment.

When making psychiatric or psychological claims, you will need to supply WorkCover or the self-insurer with details of the main factors or events you believe caused your injury including dates and information to support your claim.

WorkCover or self-insurer will supply these factors to your employer to give them an opportunity to respond.

Once the employer’s response has been received, you will have the opportunity to provide any additional information before a final decision on your workers compensation claim is made.

Other people the insurer may seek information and medical evidence from include:

  • your doctor or allied health professional, including a mental health psychologist or psychiatrist

  • direct witnesses to any events

  • further independent medical opinions

Remember though, the onus is on you, as the injured person, to prove your injuries and your claim.

Once the workers’ compensation insurer gathers all the information it requires, it will determine your claim and inform both you and your employer of their decision.

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