Your workers comp claim was denied. Here's how to ask for a review.

A treating-doctor report (sometimes called a "long-form certificate" or "specialist medical narrative") is a written statement from your treating clinician that goes beyond the standard Certificate of Capacity. Where the certificate fits on a single SIRA-templated page, a treating-doctor report runs to three to five pages and addresses the specific issues the insurer has raised. It walks through your work history, the mechanism of injury, the clinical examination findings, the imaging or pathology results, the diagnosis, and — critically — an opinion on causation.

The causation opinion is often the heart of it. The treating doctor sets out the clinical reasoning linking the work activities to the condition, with the reason in the decision letter in mind. If the reason was "pre-existing condition," the report explains the aggravation. If it was "not work-related," the report explains how the injury happened at work. If an IME took a different view, the report sets out the treating doctor's view and the history behind it.

A treating doctor's report is separate from the standard certificate, so ask the doctor how it will be billed. If you have a lawyer, an ILARS grant can fund the medical-legal reports the lawyer arranges. Our help is free: we book the appointment and help you send the report to the insurer with your request for a review.

The same logic applies when it's a specific treatment that gets declined rather than the whole claim — surgery is the common example. If an operation recommended by a WorkCover orthopaedic surgeon is declined, the surgeon can respond to the reasons given — and if you still disagree, we put you in touch with compensation lawyers who can advise on the next step, usually funded through IRO's ILARS scheme.

It's also worth checking whether a second scheme should be paying alongside this one. A worker hurt in a motor vehicle accident on the job — driving between sites, on a delivery run, in a company vehicle — is sometimes turned down on the basis that the matter belongs with the CTP insurer. Often it belongs with both, and the doctor can write the certificates for a CTP insurance claim as well. Where the injury has ended your working life altogether, Total and Permanent Disability cover inside your super is a claim against the fund rather than the WorkCover insurer, so it does not wait on the WorkCover dispute. Policy offset clauses mean the order and timing of the two claims matters, so a lawyer sequences them together rather than running them blind — our TPD payout calculator gives an indicative starting figure.