SIRA Logo

If the claim has been accepted by the insurer, why has the treatment I have recommended been refused?

When an insurer reviews any request for treatment, they consider all medical evidence. If the medical evidence indicates the recommended treatment is not reasonably necessary, it may be refused.

This evidence may be obtained from a number of sources, such as a treating specialist, independent allied health practitioner or an independent medical examiner.

If the worker wants to dispute this decision, they should contact the insurer in the first instance. If the worker is unable to resolve the matter directly with the insurer they can contact the Workers Compensation Independent Review Office (WIRO). WIRO can advise the worker (or their representative) about how to get advice from a lawyer approved under the Independent Legal Assistance and Review Service (ILARS). The lawyer will review the workers case and may make an application to WIRO to see if funding is available to have the dispute resolved by the Workers Compensation Commission.