Things to know about your Comcare claim: 5 Important Updates To The Scheme
Published on April 1, 2025 by Gemma Nelson and Laura Flanagan
The federal workers compensation scheme, commonly referred to as “Comcare”, covers close to half a million employees, that work for Commonwealth departments or large companies who are self-insured under the scheme, including Australia Post, Telstra and the Commonwealth Bank.
In the last couple of years, the legislation that covers these workers, the Safety, Rehabilitation and Compensation Act 1988 has undergone amendment, which has resulted in some important updates that workers covered by the scheme should be aware of.
Below we discuss 5 of these changes and what they mean for your Comcare claim:
1. Insurer timeframes to determine liability on your claim:
Previously one of the main complaints by workers and worker’s representatives alike was the stark contrast in obligations that existed when it came to the timeframes and the determination of claims that existed under the scheme up until 2024.
Injured workers were subject to stringent timeframes when it came to challenging an insurer’s denial of a claim however, frustratingly, the insurer had no corresponding timeframe in which they had to make a decision about an injured worker’s claim. This often meant that injured workers were waiting many months for an insurer to make a decision and during that period, the worker would be in limbo, having to rely on any accrued sick leave and to pay for medical expenses out of pocket or with some assistance from Medicare.
Fortunately, this is no longer the case. Comcare and self-insurers under the scheme are now held accountable by newly established timeframes within which they must make a decision on a claim.
Those timeframes include:
- 20 calendar days for claims made in respect of an injury (other than a disease) or an aggravation of an injury (other than a disease);
- 60 calendar days for claims made in relation to a disease; and
- 30 days to issue a reconsideration/reviewable decision if requested to do so by the claimant.
There are some exceptions to the above timeframes which can result in extensions including if additional information or evidence is requested by the insurer or if an independent medical examination is required.
If an insurer fails to determine the claim within the prescribed timeframe, the presumption is that the claim is denied, and the injured worker can then take steps to file a review application with the Administrative Review Tribunal (‘ART’).
2. Attending an independent medical examination arranged by the insurer:
Another all-too-common complaint from injured workers under the commonwealth workers compensation scheme was the insurer’s seemingly unfettered power to send a worker to an independent medical examination. There was no restriction on how many times or in what circumstances an injured worker might be forced to attend a medical examination. On the face of it, it appeared that a medical examination could be made at the whim of the insurer.
Injured workers were often subjected to seeing multiple doctors of the same specialty. There was no requirement for the insurer to provide a rationale for the assessment nor any obligation on them to consider the opinions of the injured worker’s treating doctors. Should an injured worker refuse to attend an appointment, the insurer could “suspend” the claim, meaning that the worker would not be paid their incapacity payments whilst the suspension was in place.
Pleasingly, in October 2024, Comcare issued a Guide for Arranging Rehabilitation Assessments and Requiring Examinations 2024.
This guide provides some restrictions on an insurer’s power to arrange medical examinations.
Importantly, the insurer is now required to:
- Attempt to first manage the claim based on the information which is already on file;
- Speak with the injured worker’s treating doctors about any further information they require;
- If 1 and 2 above do not sufficiently cover the information the insurer requires, a medical examination can then be arranged however, the insurer must still:
(a) Ask for the injured worker’s views about arranging a medical appointment including preference of location, gender, and qualifications of the medical examiner; and
(b) Provide written reasons to the injured worker as to why the medical examination is required.
This new Guide provides a more balanced approach to independent medical examinations and is a welcome change.
The Guide also provides that an insurer cannot arrange a medical examination if the injured worker has already attended one within the last 6 months.
The other important amendment in respect of medical examinations is that injured workers can now request a review of an insurer’s decision to arrange a medical examination. These decisions can be reviewed by the ART. Whilst certainly this is a positive development, the downside is that getting an outcome from the Tribunal is likely to still take a number of months, meaning that the injured worker’s claim would essentially be in limbo during that period.
3. The “new” Tribunal: The Administrative Review Tribunal:
A worker’s recourse if the insurer had denied their claim on review used to be to the Administrative Appeals Tribunal (AAT). In October 2024, the AAT became the Administrative Review Tribunal (ART).
As it has only been approximately 6 months since the ART has been in existence, it will remain to be seen what this change means in practice for injured workers. You can read more about the change to the ART in our other article here.
4. Changes to the onus of proof for first responders diagnosed with PTSD:
First responders, including the Australian Federal Police and the Australian Border Force employees, who are diagnosed with Post Traumatic Stress Disorder (PTSD) no longer hold the onus to prove that their psychological condition was significantly contributed to by their employment. There is now a presumption under the legislation that the first responder’s employment did significantly contribute to their psychological injury.
This amendment recognises and appreciates that the very nature of the employment of first responder’s often sees them exposed to trauma on a regular basis.
This change in the legislation should mean it is easier for first responder’s diagnosed with PTSD to have their claims accepted at the initial stage, which will allow them to access the support they require much faster.
5. The not so new amendment to the age of incapacity payments:
Whilst this amendment has been in place for a few years now (mid 2017), it can be easily overlooked. Since its’ inception in 1988 and for the succeeding near 3 decades, an injured workers’ entitlement to incapacity payments ceased at age 65 years. This was despite the Federal Government gradually increasing the pension eligibility age.
In 2017, the federal government made an amendment to the legislation which now aligns the age at which incapacity payments cease with the pension eligibility age. This closes the gap for those workers who were, prior to 2017, left in limbo in circumstances where their compensation payments had ceased but they had not yet reached the age to claim the pension.
Dealing with a workers compensation claim under the Commonwealth scheme can be complex. We would recommend that you reach out to us for advice if you are an injured worker with the Commonwealth scheme or you are thinking about lodging a workers compensation claim.
Please note that this article does not constitute legal advice. If you are seeking professional advice on any legal matters, you can contact Carroll & O’Dea Lawyers on 1800 059 278 or via our Contact Page and one of our lawyers will be able to assist you. If you or a loved one have been injured, use our Personal injury Claim Check now.
