This factsheet explains how you can ask the insurer or the State Insurance Regulatory Authority (SIRA) to review a decision about your eligibility for a SIRA-funded program to support recovery at work.
SIRA may develop, administer, coordinate and fund vocational rehabilitation schemes for workers, under section 53 of the Workplace Injury Management and Workers Compensation Act 1988.
SIRA has a suite of programs to assist workers and employers recover at work. If a worker and/or employer meet SIRA’s eligibility criteria and program requirements, the worker and/or employer’s use of the program will be accepted, and the insurer will administer the program costs.
While most applications are assessed by insurers, SIRA assesses applications in certain circumstances. For example, if the application exceeds the cost an insurer may approve, the application is reviewed by the insurer and then forwarded to SIRA to determine whether the proposal meets eligibility criteria.
If the insurer or SIRA decides an application does not meet eligibility criteria and program requirements, a worker and/or employer can request a review.
How to request a review of the insurer’s decision
Firstly contact the insurer and ask them to review their decision. You may provide additional information to support your request or application. If you need help in requesting the review, contact the Workers Compensation Independent Review Office (WIRO) on 13 94 76.
If you’re not happy with the result of the insurer’s review, you can ask SIRA to review the insurer’s decision about your eligibility for the program.
You will need to make the request in writing, outlining your reason, including:
- confirmation that the insurer has completed a review of their decision and reason(s) why the insurer has not approved your request
- supporting information to address the eligibility criteria for the program, for example, medical or workplace rehabilitation reports, course or service information
- details of all costs associated with the program
You can send your request to SIRA via email to firstname.lastname@example.org or post to the Director, Claimant Outcomes, State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2252.
If new information has been provided, SIRA will ask the insurer to review this information. If the insurer determines the worker and/or employer meet SIRA’s eligibility criteria and program requirements SIRA will advise you and close your review request.
In reviewing an insurer decision SIRA will:
- contact you or the insurer to discuss the review, and if necessary, request further information
- assess your program proposal and advise you of the outcome within 20 working days of receiving all the necessary supporting information
- provide you with an opportunity to respond
- send you and the insurer a letter to confirm the outcome of the review outlining the reason(s) why SIRA has or has not approved your application.
How to request a review of SIRA’s decision
If SIRA has not approved your application, you can request an internal review of the decision. This will be conducted by a different decision-maker within SIRA.
You will need to make the request in writing, outlining your reason and including supporting information to address the eligibility criteria and program requirements, for example, medical or workplace rehabilitation reports, course or service information.
You can send your request with any supporting information to SIRA via email to email@example.com or post to the Director, Claimant Outcomes, State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2252.
- confirm that your request for a review has been received within two working days and let you know if any further information is required
- assess your program proposal and advise you of the outcome within 10 working days of receiving all the necessary supporting information
- provide you with an opportunity to respond
- send you a letter to confirm the outcome of the review outlining the reason(s) why SIRA has or has not approved your application.
Information about privacy
SIRA needs to collect some of your personal and health information so it can conduct a review of your insurer’s decision. SIRA may also collect information from your insurer.
You do not have to provide us with all information requested. However, if you do not provide this information, we may not able to assess your request.
We will use your information for the purpose of conducting the review.
We may disclose your information to your insurer so that we can conduct the review. SIRA will not disclose your information without your consent unless authorised by law.
We will hold your information at State Insurance Regulatory Authority, 92-100 Donnison Street, Gosford NSW 2250.
You have the right to access and correct your personal information. To access or update your personal information, please call us on 13 10 50 or email firstname.lastname@example.org
For further information please visit www.sira.nsw.gov.au/privacy.
If you not are not happy with SIRA’s review, you may wish to seek legal advice.
More information about SIRA-funded programs to support recovery at work is available from www.sira.nsw.gov.au