QLD Workers’ Compensation: The workers’ compensation insurer has made a decision I disagree with. Can I have this decision reviewed?

The Workers’ Compensation and Rehabilitation Act 2003 (QLD) (‘the Act’) establishes the office of the Workers’ Compensation Regulator, which is responsible for undertaking reviews of insurer decisions made pursuant to Chapter 13 of the Act. This role is performed by the Office of Industrial Relations, who aims to provide independent and non-adversarial review of certain decisions made by workers’ compensation insurers.

Reviewable Decisions

Not all decisions made by insurers can be the subject of an application for review. Decisions that can be reviewed include, but are not limited to: – 

  • A decision to allow or reject an application for compensation; 
  • A decision to terminate or suspend payment of compensation;  
  • A decision about the time to apply for compensation; or  
  • A decision to increase or decrease weekly payment of compensation. 

Common decisions that are not capable of being the subject of an application for review include a decision not to fund a particular medical procedure.  

The application for review may be lodged by a worker, a claimant, or employer who was aggrieved by a decision or the failure to make a decision.  

Application Form

The application for review must be made in the approved form, being a pro forma application form provided by the Workers’ Compensation Regulator. The application for review must state the grounds on which the applicant is seeking review and can be accompanied by any relevant documentation.  

Time Frames

If not already provided, a worker, claimant, or employer may request from the insurer written reasons for decision within twenty (20) business days of being advised of that decision.  

Thereafter, an application for review must be made within three (3) months of receiving the written reasons for decision document from the insurer.  

It is possible to have an application for review to be lodged outside of this three (3) month period, pursuant to ss 542(2) and (3) of the Act. However, the Regulator must be satisfied that special circumstances exist that prevented the lodgment of the application. Such circumstances may include medical circumstances that meant the Applicant was not capable of lodging the review within three month, if accompanied by medical evidence in support. An extension of the timeframe for submission can only be granted once, as the Regulator does not have the jurisdiction to grant further additional extensions.  

Following lodgment of the application, the Workers’ Compensation Regulator must make a decision within twenty-five (25) business days, unless an extension is granted. The written decision will then be provided to the parties within ten (10) days. The Regulator will either confirm the original decision, vary the original decision, set aside the original decision and substitute another decision, or set aside the original decision and return it to the Insurer with directions.  

Conclusion

If you have received a decision from a workers’ compensation insurer that you disagree with, and you wish to lodge an application for review, then time is of the essence. Whilst the Regulator has the jurisdiction to grant an extension of the timeframe for submission, this is at its discretion and you will need to demonstrate that special circumstances exist. As such, you should not rely on the grant of an extension.  

If you require assistance in relation to a work injury, please do not hesitate to contact us.   

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