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Claims managers

For: Claimants Employers and managers Service providers Advocates Information seekers

A claims manager manages an employee’s claim for compensation for a work-related injury or illness, under the Safety, Rehabilitation and Compensation Act 1988.

This includes determining if the claim is accepted and if there is liability for support and benefits.

The role explained

Claims managers assess and manage claims for compensation.

They support employees throughout the compensation claim process.

Claims managers recognise that each individual claim is unique, which requires a personal approach to support the differing needs of each employee.

They work closely with the employee, their employer, treating practitioners and rehabilitation case manager to support the employee to achieve return to health and work outcomes in a safe and sustainable manner.

Responsibilities of claims managers

Claims managers have a responsibility to:

make accurate and timely decisions on claims
provide clear reasons for decisions and determinations
ensure that entitlements for treatment and income support are processed
ensure treatment meets the principles of the Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB) and provides the best health outcomes.

Who manages the claim

Table 1: Claims management arrangements for employees in the Comcare scheme
For employees of:	The claim is managed by:
Australian Government agencies and statutory authorities	Comcare
Australian Government agencies with a delegated claims management arrangement	The employer, a claims management provider contracted by Comcare, or Comcare.
Self-insured licensees	The employer or their approved claims management provider.

Information for claims managers

Core capabilities

Claims manager core capabilities (PDF, 193.1 KB) – defines the capabilities required of a claims manager to work effectively with a rehabilitation case manager to coordinate an employee's rehabilitation and return to work.

Scheme guidance

We provide scheme guidance to help you understand and apply the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).

Discover our guidance on applying the SRC Act

Training for claims managers

We provide training through our learning management system called Comcare LMS.

To access our training, you first need to create an account in Comcare LMS (see the steps to create an account). Then, select the training item that you are interested in and login with your email and password.