Sometimes a worker and the insurer disagree on the offer of settlement for lump sum compensation as a result of a work related injury.
This is usually when the worker and insurer have both sought assessment of permanent impairment but the two assessments do not give the same degree of assessed permanent impairment.
When the insurer disputes liability for your claim for lump sum compensation, and/or the level of permanent impairment in relation to a threshold, they will advise you of their reason(s) in writing and provide information on the next steps available to you.
If you have received the decision notice, with supporting reasons provided by the insurer, and you dispute the notice, you can apply to have the dispute resolved in the following ways.
Request a review by the insurer
You may contact the insurer and request they review the decision.
The insurer will advise you of the procedure to request the review and forward you any relevant forms or documents you may need, if they have not already done so.
When requesting the review, you should explain why you are requesting it and include any additional information you think is relevant to help the insurer review the decision.
It is important you include all relevant information now, as you may not be allowed to introduce new material if you later choose to lodge an application to resolve the dispute at the Workers Compensation Commission.
The insurer must respond to you in writing within 14 days of receiving the request for a review.
As a worker, you can contact the Workers Compensation Independent Review Office (WIRO) if you are dissatisfied at any stage during this process, need assistance or information.
WIRO is an independent statutory office with a variety of roles, including helping find solutions to disputes for injured workers.
When an initial complaint becomes a dispute, the Workers Compensation Independent Review Office (WIRO) can advise you (the worker) and your representative about how to get advice from a lawyer approved under the Independent Legal Assistance and Review Service (ILARS). The lawyer will review your case and may make an application to WIRO to see if funding is available to help resolve the dispute in the WCC.
For more information about how WIRO can help, you can:
Apply to the Workers Compensation Commission
The Workers Compensation Commission (WCC) is an independent tribunal that helps resolve workers compensation disputes between workers, employers and/or insurers. You do not need legal representation to make an application to the WCC.
If you are not satisfied with the insurer's decision on the assessed degree of permanent impairment as a result of your work-related injury, you can lodge an application to the WCC.
The WCC will refer the dispute to an arbitrator who can either determine the degree of permanent impairment or refer the dispute to an Approved Medical Specialist (AMS) for an assessment.
Any party to the dispute may appeal the medical assessment certificate based on specific grounds set out in the legislation.
If this occurs a medical appeal panel will review the assessed level of permanent impairment and make a determination.
For more information visit the WCC website or call 1300 368 040.