My insurer has accepted a claim which i know to be

My insurer has accepted a claim which i know to be illegitimate and i want to know what avenues of appeal / review of the decision i have. Your assistance would be greatly appreciated

Lawyer's Assistant: What state/territory is this in? It matters because laws vary by location.

Victoria

Lawyer's Assistant: What steps have been taken so far?

The claim has been investigated by Elite investigations who have exposed the worker as a liar who boasted and discussed his intention to stage an injury the claim was accepted on the medical advice / scans. The worker told them he was going to do this because he did not get the pay rise he asked for. This was the first certificate of capacity. He was back at work with 3 days off and resumed work for almost 3 weeks. A second certificate of capacity was received came about as a direct result of disciplinary action for severe misconduct - abusive offensive and aggressive behaviour toward a fellow employee. The second certificate assessed him at NO capacity to work at all all of a sudden. he left the meeting angry and verbally resigned storming out and as he left he stating that he would be taking his brother with him ie his brother would be resigning too. Neither worker attended work the next day and that evening we received the second certificate of capacity.

Lawyer's Assistant: Anything else you want the lawyer to know before I connect you?

The workers who were in the same section were relieved and happy that he had resigned but are very concerned about whether the worker will be back. he was intimidating, bullying and abusing them and threatening to get them sacked as he was the supervisor and management would do what he said.