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Merit reviews of work capacity decisions

The information below is only for workers who have a work capacity decision notice dated before 1 January 2019 and have requested an internal review by the insurer from 1 January 2019 to 30 June 2019.

Workers who have a work capacity decision notice dated before 1 January 2019, and who have requested an internal review by the insurer between 1 January 2019 and 30 June 2019 inclusive, can request a SIRA ‘merit review’ if the worker is unhappy with the outcome of the insurer's internal review.

Note: if the worker has received an internal review decision by the insurer, the 30-day time limit for requesting a SIRA merit review still applies.

To request a merit review, use the Work capacity decision - application for merit review by SIRA.

Conducting merit reviews

If the application is accepted, an independent decision maker from the SIRA Merit Review Service will conduct a merit review of the insurer’s work capacity decision and will outline findings and recommendations. These are binding on the insurer.

They will send the details of the findings and recommendations (with their reasons) to the worker and the insurer as soon as possible, and preferably within 30 days of the application for merit review being lodged.

The 2016 guidelines for claiming workers compensation (effective from 1 August 2016 to 31 December 2018) and the Merit Review Guides have detailed information about the processes for merit reviews.

Stay of a work capacity decision

A review of a work capacity decision may operate to stay (temporarily suspend) the work capacity decision that is under review. The insurer will explain how a stay may apply to your circumstances.

Procedural review of a work capacity decision

If, after being informed of the findings of the SIRA merit review, the worker remains dissatisfied with the work capacity decision, a procedural review of the insurer's work capacity decision can be sought by applying to the Workers Compensation Independent Review Office (WIRO).

Please contact WIRO on 13 94 76 or visit their website for more information.

Related forms and publications

The following forms and publications have been archived and are only relevant when a worker has a work capacity decision notice dated before 1 January 2019, and has requested an internal review by the insurer from 1 January 2019 to 30 June 2019.