Many clients mistakenly think that once their claim is accepted by Comcare, they will automatically start receiving benefits without needing to take any action.
This brief guide provides an outline of some the steps that you will need to take to ensure that you receive your entitlements and covers some of the most frequently asked questions that we receive.
The most important thing is to remain honest and maintain your integrity. If there is a change for better or worse to your accepted condition or your capacity to work, this will need to be reflected in a fresh medical certificate.
You also need to make sure that you do not do anything which is substantially inconsistent with your medical certificate.
In particular, we urge you to be careful about what information you post on social media; we have been involved in cases where Comcare has used Facebook posts to challenge credibility. Using pseudonyms or false names will not necessarily protect you.
Administrative Tips for Dealing with Comcare:
1. Make sure that your name and Comcare claim number are referenced in the subject line of any email to ensure your email is automatically scanned to your file.
2. Keep a copy of every email that you send and every reply you receive for your records.
3. Always communicate with Comcare in writing by email and ask them to communicate all decisions in writing.
1. You will not receive incapacity payments unless you lodge the relevant paperwork with Comcare, and your employer, if applicable.
2. Make sure that your medical certificate is up to date. Your entitlement to ongoing incapacity payments is informed by your doctor’s certification of your capacity, treatment and/or rehabilitation needs and nexus with employment.
3. Email your latest medical certificate and “Claim for Time Off Work Form” to your agency and CC firstname.lastname@example.org if you are still employed by your agency. If you are not employed, send your certificate and form directly to email@example.com.
4. Monitor whether you are receiving the correct amount; if you are not you should query it in writing. We recommend that you seek legal advice.
5. If Comcare denies that you are entitled to incapacity payments for any reason and you continue to be incapacitated for work, you should seek reconsideration within 30 days. We recommend that you seek legal advice.
1. It seems obvious but if you do not inform Comcare that you have a medical expense which requires reimbursement, they cannot reimburse the expense.
2. You need to scan vouchers and receipts for treatment expenses and email them to firstname.lastname@example.org requesting reimbursement.
3. If Comcare denies reimbursement for any reason you should seek reconsideration within 30 days. We recommend that you seek legal advice if at all uncertain.
Notice of Intention to Cease Entitlements or Determine no Present Liability:
If Comcare sends you a “notice of intention to cease entitlements” or “notice of no present liability” this means that Comcare is considering denying your entitlements for whatever reason(s) (perhaps they consider your condition has resolved).
You should always respond. We recommend that you promptly seek legal advice.
If you receive a negative decision on reconsideration, you will have 60 days from when you receive the decision to lodge a review at the Administrative Appeals Tribunal. We recommend that you promptly seek legal advice.
You have an ongoing requirement to participate in any reasonable rehabilitation (subject to the restrictions on your medical certificate). However, it is important to remember that you do have a need and right to privacy and safety and for this reason we suggest that you request that your rehabilitation provider is not present during clinical assessments or, that you ask your rehabilitation provider to join you later in your medical appointment. If you have concerns, seek advice.
Comcare has the right to request that you undergo examinations by doctors of their choosing from time to time. Unless the request is legally “unreasonable” it is a requirement of your ongoing incapacity compensation rights that you attend.
If you are too unwell you must go to your treating doctor, be certified as such and submit the certificate to Comcare. There may be few circumstances where you would be considered to be too unwell to attend.
The most important thing if you receive an adverse decision from Comcare is that you do not panic, and you act promptly if you intend to challenge the decision(s).
We recommend that you obtain competent legal advice from a lawyer who practices in the area because the Safety Rehabilitation and Compensation Act 1988 is an extremely complex area of law.
It is important that you do not seek legal advice from your treating practitioners because their job is to treat you and not to act as your advocate. Further, we have seen many cases where well-meaning treating practitioners in an attempt to help their patients state that the compensation process and decisions that Comcare makes are injuring the claimant further. This is not helpful because the Act specifically states that an injury caused by the compensation process or rehabilitation is not compensable.
It is important that you do not make assumptions about the correct strategy to adopt, arguments to be made and evidence to be sought.
If your injury is an aggravation of an underlying injury, or your injury requires you to make arguments that go to whether the reasonable administrative action exception applies, these are particularly complex areas of law and we strongly suggest you seek legal assistance.
In order to provide your lawyer with the best possible chance to build your case, they will need all documents that were in front of Comcare at the time of the decision.
Even before you seek legal advice, we recommend that you request your case file from Comcare if you do not have all of the documents yourself so that you can hand these to any lawyer from whom you seek advice. A competent lawyer will be unable to provide you with comprehensive legal advice unless they have the relevant documents. Seeking documents early will prevent delay.
If the decision that you received was what is called a primary decision (the first decision that Comcare has made on this particular issue) you will have 30 days from receipt to seek reconsideration. If you have already sought reconsideration and received a negative decision, you have 60 days from receipt to lodge a request for review with the Tribunal.
If you look at the Comcare website, you will see that the number of claims that are being accepted by Comcare at first instance have significantly reduced and that the claims that are affirmed on reconsideration are very high (usually in the high 80th percentile). This is why it is critical to seek competent legal advice.