What To Do if Your Claim is Pended by the Insurer

If you’ve been injured in the workplace, you’ll need to notify your employer immediately, and also make a claim to WorkCover. WorkCover is a regulatory government body to oversee worker’s compensation and injury management within Western Australia, and they also monitor compliance within claims during the often lengthy and complex process.

In the event your worker’s compensation claim is accepted by your employer’s insurance, any due compensation will be made to you for any wages, medical expenses, rehabilitation expenses or travel and accommodation expenses you may have incurred as a result of your injury. But what if your claim is flagged as “pended”? What does this mean, how could it affect you, and what should you do? Let’s find out.

1. WHAT DOES “DECISION PENDED” MEAN?

Should you lodge a worker’s compensation claim, the insurer will accept, dispute or put the claim on hold pending further information. This deems the decision as “pended”. Your employer’s insurance company should notify WorkCover, your employer and you on the outcome of the claim in writing within 14 days – whether they deem it accepted, disputed or pended.

2. HOW DOES A PENDED CLAIM AFFECT ME?

Statutory requirements dictate that once an insurer is provided with the claim form, they have 14 days to make a decision on who is to be held liable, or 17 days if your employer is self insured. If the insurer flags your claim as pended, they may undertake further investigations and obtain more information from your employer, GP, or other stakeholders so that they can then determine who is held liable.

If your claim has been determined as pended, you may consider using any accrued sick or annual leave while your claim is being assessed, to provide you with financial support during this time. If your claim is then accepted, your employer will reinstate any leave you may have used. As always though, it’s vital to obtain legal advice prior to taking any action.

3. WHAT IF THE INSURER DOESN’T PROVIDE A RESPONSE?

What many people don’t know is that if the insurer doesn’t make a decision within the 14 (or 17) days of receiving the claim form, you as the injured worker are automatically entitled to receive weekly compensation payments. As few are aware of this, it’s important to know your rights and entitlements, and seek legal advice if you are unsure.

4. WHAT SHOULD I DO ONCE I HAVE LODGED A CLAIM?

Really, the best thing to do is sit back and wait for news of the outcome of your claim. If 14 days passes and you have not heard from the insurance company, it’s definitely time to consider legal advice.

If you’re uncertain about the progress of your claim and think the insurance company hasn’t provided a response within their required timeframe, it’s really important to get advice from a personal injury lawyer, such as Peninsula Personal Injury Lawyers. We can contact WorkCover direct to ascertain the exact date they were notified, and determine if you are entitled to any compensation payments in the interim period.