Why am I being singled out?

Dr David Colvin workers compensation

13/06/2018 Dr. David Colvin, trained in orthopaedic surgery in Perth. David's specialty is knee and shoulder surgery and sports injuries.

To the insurance company, a workers’ compensation claim is just another insurance claim, no different to a car accident.  By its very nature, any insurance system is somewhat adversarial.  Insurance companies always ask questions about the validity of a claim.  I myself can clearly recall a rather unpleasant conversation with a motor vehicle damage assessor that occurred over twenty years ago.  He was firmly of the opinion that not all of the dints in my car had been caused by the recent accident.

When the insurance company starts asking questions about your workers’ compensation claim, it is easy to feel that you are being singled out.  This is not the case.  They ask questions about every claim.  Just as my car had some pre-existing dints in it (I can admit that now), you may well have some pre-existing injuries or medical conditions that are relevant to your current claim.  That does not mean that your claim will be declined.  The workers’ compensation legislation is very clear on this point.  The work injury does not need to be the sole cause of your current problem.  It only needs to be a “significant contributing factor”.

I say to people “it is important not to take the investigation process too personally.  You are not being singled out by the insurance company for special investigation.  Your claim is being managed by someone in an office in the city who does not know you personally.  They always ask questions of this nature.”

Some claims are not accepted immediately and approval is withheld pending further investigation.  This rarely leads to the claim being declined in my experience.  It may require further reports from your GP, specialist, or an independent medical examiner.  This is normal due process for an insurance company.  The key is to get these reports done quickly so that treatment is not delayed.

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