What is a section 78 notice?
A section 78 notice is a document prepared by the insurer that informs a worker that a decision has been made to decline a claim for wages and/or treatment.
The notice must set out the reasons for denying the claim and the effect of the decision.
Any documents or evidence relied on in making the decision to deny the claim must also be attached to the notice.
Most of the time when a case has been denied the insurance company simply needs more time to investigate the matter and their decision can be overturned with the help of a solicitor or Medical Evidence stating otherwise. People often think the denial ends their case – which is wrong. The insurance company can decline certain parts of a Workers Compensation claim such as particular requests for treatment. For example, a client received a denial notice for a treadmill that they were recommended by a doctor. The insurer stated: “We are therefore disputing liability in relation to the request for a treadmill only.”
A big red flag to help clients identify if their claim has been denied is if their weekly payments have ceased or their medical expenses are not being paid for or referrals approved.
Right of Review
A worker has the right to seek a review of an adverse decision. For most employees injured at work in NSW, an Approved Lawyer can assist you at no cost if there has been a dispute about liability for your claim.
If you have received a section 78 notice, we recommend that you contact Walker Law Group today so that we can assist you by investigating the decision and obtaining the evidence needed to have the declinature overturned.
If an adverse decision is not overturned on review, the team at Walker Law Group can take your case to the Personal Injury Commission, which is the tribunal that deals with disputes regarding workers compensation claims, to have your dispute overturned.
At Walker Law Group, we have seen a trend of insurers issuing verbal declines in NSW workers compensation claims.
A common example arises when a case manager calls a client to advise them over the phone that the insurer will not covering the cost of something that has been claimed, such as treatment or
surgery, and a formal section 78 notice is not issued.
The workers compensation insurer has a statutory obligation to issue a section 78 notice if liability is disputed for any aspect of your claim.
If you have received a verbal decline on an aspect of your claim, ask you insurer to provide you with a written notice and contact the team at Walker Law Group who can assist you by investigating this and providing further advice.
You’ve been declined! What do you do?
If you have received a denial, then you should contact the team at Walker Law Group. We have a team of Approved Lawyers who can assist eligible NSW injured workers at no costs to the injured worker. We will write to the Independent Review Office (IRO) to seek a grant of funding and will gather evidence to challenge the insurer’s decision.