Request a review by the insurer
If the decision notice is dated before 1 January 2019, the worker must request an ‘internal review’ by the insurer before a SIRA ‘merit review’ can be requested.
An internal review is a review of the work capacity decision by the insurer. It is conducted by someone other than the person who made the initial decision.
The review will consider the information used in the initial decision, as well as any further information you provide to support your internal review application.
A completed Application for internal review by insurer form is required to begin the process.
The insurer will contact the worker within seven days of receiving the application and explain their internal review procedure.
The insurer is required to complete the internal review within 30 days from the date of the application and notify the worker of the outcome in writing.
If the worker is unhappy with the outcome of the insurer's internal review, the worker can then apply to SIRA to conduct a 'merit review' of the work capacity decision.
Request a merit review
If the worker still disagrees with the insurer after the internal review, an application can be made to SIRA’s workers compensation merit review service (MRS) for a merit review of the decision.
SIRA has created an easy-to-use online portal where an application (and supporting documents) to have the decision reviewed by SIRA can be submitted.
This is called lodging an application for 'merit review'. Click the button below to log in to the merit review portal. It is also possible to still submit a paper application form if preferred.
Conducting merit reviews
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 and the dispute resolution services guide to workers compensation merit reviews has detailed information about the processes for merit reviews.
A list of merit reviewers is available on our website.
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.
A worker may seek advice from a legal practitioner about an application (or proposed application) for merit review of an original work capacity decision made by the insurer on or after 16 December 2016.
The insurer is liable to pay costs for this advice. However, this advice must be sought and received promptly. Legal costs will not be payable if the worker receives legal advice more than 30 days after being notified of the insurer's internal review decision.
For guidance regarding work capacity assessments and decisions made prior to 1 January 2019, refer to the Guidelines for claiming workers compensation (effective from 1 August 2016 to 31 December 2018).
Contacting the Workers Compensation Independent Review Office (WIRO)
NOTE: This section applies to work capacity assessments and decisions made prior to 1 January 2019
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 WIRO (WIRO).
Please contact WIRO on 13 94 76 or visiting their website for more information.