If the insurer disputes liability for your claim there are ways you can dispute that decision.
Examples of when these disputes can happen, include:
- the insurer does not consider the person making the claim to be a ‘worker’
- the insurer considers that employment was not a substantial contributing factor to the injury
- the claimed medical expenses are not reasonably necessary because of the injury
When disputes happen there is help available to have it resolved. Give us a call on 13 10 50 and we can also talk you through the process outlined below.
Request a review by the insurer
When you do this they will send you an application form (or show you where you can find one on their website).
On the application form you should explain why you are requesting the review and include any additional information you think is relevant to the decision.
It's very important you include all relevant information now because 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. The insurer will either decide to accept the claim or maintain its decision.
If the insurer fails to attach all relevant documents or communicate everything they are required to, then the insurer must correct the dispute notice(s) as soon as they become aware.
Request a review by the WCC
If you do not wish to seek a review by the insurer or are not satisfied with the insurer's decision review, you can lodge an application to dispute the decision with the Workers Compensation Commission (WCC).
The WCC is a government agency who helps resolve workers compensation disputes between injured workers, employers and/or insurers.
Examples of the disputes they resolve include:
- weekly payments and compensation
- medical, hospital and related expenses
- permanent impairment compensation
- compensation for death of a worker
- compensation for damage to personal property
- compensation for domestic assistance
If you do apply to have the dispute resolved by the WCC, only the information included in your original application to the insurer (or dispute notice) will be considered.
That’s why it’s important for you to include all relevant information when you request a review with the insurer.
In some cases the WCC may allow new information.
The process for resolving your dispute depends on the type of claim that is in dispute.
For most other claims (eg compensation, medical expenses, or where liability is disputed) the WCC will appoint an arbitrator. Arbitrators are independent legal professionals, experienced in the workers compensation system.
For more detailed information you can visit their website or call 1300 368 040.
Contact the WIRO
You can contact the Workers Compensation Independent Review Office (WIRO) if you are dissatisfied at any stage throughout this process.
The WIRO is an independent statutory office with a variety of roles, which include helping find solutions to disputes by contacting the insurer directly on your behalf.
Where disputes cannot be resolved, they can help injured workers seek free legal advice through the Independent Legal Assistance and Review Service
For more information about how WIRO can help, you can: