What are my Options if I Disagree with WorkCover’s Decision?

Context

This article is relevant to the situation where someone in Queensland has a work injury claim and they have lodged a claim with their employer for weekly benefits and/or treatment expenses.

 The employer’s insurer – usually WorkCover (though sometimes an employer is self insured) – will make various decisions through the stages of the claim process.

 For example, WorkCover Queensland may make decisions regarding:

•  an injured worker's entitlements to weekly benefits,
• medical treatment, and
• compensation benefits.

 This article sets out information relevant where WorkCover Queensland (or a self-insurer) has made a decision you disagree with.

What can you do if you Disagree with WorkCover’s Decision?

 If you disagree with the decision of WorkCover, you may have the right to:

• seek a review of that decision or
• lodge an appeal.

However, not every decision is reviewable.

What does the relevant law say?

 Section 540 of the Workers’ Compensation and Rehabilitation Act 2003 sets out which decisions may be reviewed.

 For example, Section 540 allows for review of the following:

• A decision to allow or reject an application for compensation.
• A decision to terminate or suspend payment of compensation.
• A decision to increase or decrease weekly payment of compensation.
• The failure of the insurer to make a decision on an application for compensation.
• A decision about the time to apply for compensation

What is the Process for Review?

When WorkCover Queensland (or a self-insurer) makes a decision they will generally notify if the particular decision is reviewable. If the decision is reviewable, they should  confirm the review process and the time limits that apply within their ‘Reasons for Decision’.

Both the injured worker and their employer are entitled to apply for a decision to be reviewed by the Workers Compensation Regulator.

The Workers Compensation Regulator

When an application for review is made to the Regulator by either the injured worker or the employer, the Regulator will consider the application together with any supporting documents, including:

• statements,
• medical reports,
• records and
• employment information.

The Regulator generally attempts to make a decision within 25 business days of the application however it can typically take around three (3) months for a decision to be made.

Time Limits when Applying for a Review of a WorkCover Decision.

It is important to act quickly if considering applying for a review as there are strict time limits that apply.

3 Month Time Limit.

An injured worker has 3 months from that date of receiving a reviewable decision to request a review from the Workers’ Compensation Regulator.

If steps are not taken within this timeframe an injured worker is generally precluded from making an application for review.

What if you Disagree with the Review Decision?

If an injured person or an employer disagrees with the review decision, an appeal can be made to the Queensland Industrial Relations Commission (QIRC).

The QIRC will hold a hearing to determine the matter. This can be a complex and lengthy process.

Also, time limits apply for making an appeal. An injured worker or employer has 20 business days (from receiving the review decision) to appeal the review decision. The appeal is made to the Queensland Industrial Relations Commission.

A Final Observation

The ability to be able to review or appeal decisions during a WorkCover claim is an important right in the work claims process.

Understanding your rights can make a significant difference to the outcome of a compensation claim.

It is always important to seek legal advice from an experienced personal injury lawyer.