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. This is also known as a dispute.
When the insurer disputes liability for your claim for lump sum compensation they will advise you of their reason(s) in writing and provide information on the next steps available to you.
Once you have received the notice of dispute, with supporting reasons provided by the insurer, you can apply to have the dispute resolved in the following ways.
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
The first step is to 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.
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'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.
You can contact the Workers Compensation Independent Review Office (WIRO) if you are dissatisfied at any stage during this process.
WIRO is an independent statutory office with a variety of roles, including helping find solutions to disputes by contacting the insurer on your behalf.
Where disputes cannot be resolved, workers can apply for legal aid through the Independent Legal Assistance and Review Service.
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.
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 to have the degree of permanent impairment assessed by an approved medical specialist.
The approved medical specialist is appointed by the President of the WCC to assess medical disputes, including the degree of permanent impairment for the WCC.
The WCC will appoint an approved medical specialist to your case to conduct the assessment and provide a medical assessment certificate indicating the assessed degree of permanent impairment.
Any party to the dispute may appeal the medical assessment certificate on the basis of 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.
If you do apply to have the dispute resolved by the WCC, only the information included in the insurer’s original dispute notice and the documents you submitted for this initial insurer review will be considered (unless there are exceptional circumstances). That’s why it’s important for you to include all relevant information when you request an insurer review.
For more information visit their website or call 1300 368 040.