Independent review of insurer decisions

The Workers' Compensation Regulator is responsible for undertaking reviews of insurer decisions under Chapter 13 of the Workers' Compensation and Rehabilitation Act 2003. This function is delegated to and undertaken by the Office of Industrial Relations, which aims to provide independent, prompt, non-adversarial review of certain decisions made by insurers.

If a worker, claimant or employer is unhappy with a decision made by WorkCover Queensland or a self-insurer they may be able to ask the insurer for a reasons for decision document within 20 business days of being advised of the decision.

A worker, claimant or an employer is then able to lodge an application for review with the Office of Industrial Relations within 3 months of receiving the insurer's written decision.

Whoever lodges an application for review is known as an Applicant.

The other party to a review will either be the worker or employer depending on who lodges the review.

The review process is not a court process. It involves a review by a Review Officer of all the documentation available in relation to a worker's application for compensation. The Review Officer does not re-investigate an application for compensation and will not request further information from the applicant or the other party.

What types of decisions are reviewable?

Not all insurer decisions can be reviewed.

Section 540 of the Workers' Compensation and Rehabilitation Act 2003 sets out a list of decisions that can be reviewed. A few of these include:

• 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
• A decision to set the premium payable under a policy
• A decision to issue a reassessment premium notice
• A decision not to waive or reduce a penalty
• A decision not waive or reduce a late payment charge.

Examples of decisions that are not reviewable include:

• A decision by an insurer regarding ongoing management of the application for compensation
• A decision not to fund a particular medical procedure
• A decision not to apply the premium discount.

Some of these decisions may however be appealable to an Industrial Magistrate. For more information, please refer to the section on Appeals.

If a worker, claimant or employer is unhappy with the insurer's approach in determining an application for compensation, this is not something that can be reviewed. However a complaint can be lodged directly with the insurer.

If a worker, claimant or employer is not sure if a decision is reviewable, an application for review can still be lodged, however it will need to be assessed to determine if it is a reviewable decision.