For individuals dissatisfied with decisions made by WorkCover Queensland or a self-insurer, an avenue for independent review exists through the Workers' Compensation Regulator, as outlined in Chapter 13 of the Workers' Compensation and Rehabilitation Act 2003. The review process, facilitated by the Office of Industrial Relations, aims to provide an impartial and efficient assessment of specific decisions made by insurers.
How Does an Inpendent Review Work?
Should a worker, claimant, or employer seek clarification on a decision, they can request a reasons-for-decision document from the insurer within 20 business days of being informed of the decision. Subsequently, the concerned party, known as the Applicant, can submit an application for review to the Office of Industrial Relations within 3 months of receiving the insurer's written decision. The independent review involves a comprehensive assessment of available documentation related to the application for compensation, undertaken by a Review Officer, without initiating a new investigation or requesting additional information.
Reviewable decisions, as defined in Section 540 of the Workers' Compensation and Rehabilitation Act 2003, include determinations on compensation applications, payment terminations or suspensions, adjustments to weekly compensation, failure to decide on an application, timing of compensation applications, premium setting under a policy, reassessment premium notices, and penalty waivers. Certain decisions, such as ongoing management, medical procedure funding, or premium discount applications, are not subject to review but may be appealable to an Industrial Magistrate.
In instances where uncertainty arises about the reviewability of a decision, an application for review can still be lodged, with subsequent assessment to determine its eligibility for review. Dissatisfaction with an insurer's approach to compensation applications can be addressed through a direct complaint to the insurer.