What happens after you submit a claim

After you submit your claim, it’s assigned to a claims manager. Your claims manager will contact you to acknowledge your claim.

How claims are assessed

Your claims manager will assess your claim against a set of criteria. Your claim will be successful if:

• you are covered by the Comcare workers’ compensation scheme
• you reported your injury or illness as soon as you could
• you provided all the necessary documents
• your injury or illness is work-related 
• the injury or illness led to incapacity, impairment or death
• there are no special circumstances that mean the claim is excluded.

Read more about the claim assessment criteria.

Claims managers sometimes need help to interpret and assess medical information. If your claim is being managed by Comcare, your claims manager can get expert advice from our:

• clinical panel of independent doctors and allied health professionals
• injury managers, a team of allied health professionals.

Providing more information for your claim

To assess your claim, your claims manager will start by looking at the information from you, your employer, your doctor and any other medical professionals treating you.

Your claims manager may decide they need more information to make a decision on your claim. They may:

• ask you to provide an employee statement
• ask your employer for more information
• ask for more information from the medical professionals treating you
• ask you go to an independent medical examination.

How long will a decision take?

Under the law that governs the Comcare scheme, claims managers have a set amount of time to make a decision. The timeframes are paused when the claims manager is waiting for any extra information they need. The timeframes are:

• 20 calendar days for injury claims (plus any time spent gathering more information)
• 60 calendar days for illness claims (plus any time spent gathering more information).

How long a claim decision takes varies. It depends on things like:

• whether your claim is for an injury or an illness, and its complexity
• the complexity of your work circumstances
• whether your claims manager needs extra information, and how quickly they receive it.

Your claims manager should give you an estimate of how long a decision on your claim is likely to take, and keep you updated throughout the process.  

You can help to keep your claim moving by:

• responding promptly to any requests for information
• contacting your claims manager if you have questions about the information they’ve requested
• encouraging your medical providers to provide requested reports promptly.

While you wait for a decision

While you’re waiting for a decision on your claim, continue getting the treatment you need and start thinking about your return to work. Talk to your employer about accessing any leave you have. You can also explore other financial support you may be eligible for. 

Get treatment

Get the treatment you need and talk to your doctor about support you may need to get back to work.

Keep invoices and receipts for medical costs. You may be reimbursed for these later if your claim is accepted.

Use your leave

If you’re still employed, you can use your personal or annual leave while you wait for a decision on your claim. If your claim is accepted, your leave entitlements will be re-credited to you.

Talk with your employer about support they can provide

You may want to ask your employer what support they can give you.

You may be able to access free and confidential support and counselling through an Employee Assistance Program.

Your employer may also have an early intervention program that provides supports and services to help you recover and return to work. Using early intervention programs does not affect your right to claim workers’ compensation. 

Other financial support

You may be eligible for: 

• Centrelink payments – use the Services Australia Payment and Service Finder to explore payments and services 
• income protection insurance – contact your super fund to find out whether you have income protection insurance as part of your superannuation and if so, how to claim.

If your workers’ compensation claim is accepted and you receive incapacity payments, these can affect your Centrelink or income protection insurance payments. Tell Centrelink or your insurer that you are waiting for a decision on a workers’ compensation claim.

Financial counselling is a free, confidential and independent service that offers practical advice and support to people having financial difficulty. Contact:

• National Debt Helpline on 1800 007 007
• Mob Strong Debt Help on 1800 808 488 for Aboriginal and Torres Strait Islander people nationwide.