Disputes and complaints

The period after a work-related injury or illness can be complex and challenging for both employers and workers. The uncertainty that can sometimes follow may lead to complaints and disputes.

Workers compensation disputes, complaints and unresolved enquiries

icare recognises that early engagement can help prevent a smaller issue from escalating into a larger dispute.

We have dedicated teams to help you with complaints, enquiries and disputes and will continue to work towards early resolution of liability and work capacity issues wherever possible.

Disputes versus complaints

There is a difference between a dispute and a complaint.

A workers compensation dispute may arise when an insurer fails to determine a claim or makes a decision on a compensation claim that a claimant disagrees with. Examples include (but are not limited to) work capacity decision disputes, permanent impairment and medical disputes, liability disputes and injury management disputes.

A complaint is any expression of dissatisfaction made which relates to an organisation’s products, service or the complaints handling process, where a response or resolution is explicitly or implicitly implied.

A complaint can relate to the conduct of the insurer, employer or provider.

There are independent pathways for both employers and workers to lodge a dispute or make a claim.

Pathway for disputes

From 1 January 2019 the Workers Compensation Commission (WCC) is the central body for resolving all workers compensation disputes. From 1 March 2021, the Workers Compensation Commission will be known as the Personal Injury Commission (PIC).

Workers have the choice to apply for an internal review of a decision by the insurer (who must respond within 14 days of receipt). Alternatively, workers can lodge dispute directly with PIC.

icare encourages workers to seek to resolve the dispute early, directly with the insurer.

The disputes and litigation process

Dispute resolution process

icare is responsible for actioning applications for insurer reviews (pre-litigation disputes).

The legislation provides a worker with this dispute resolution pathway.

Decisions icare can review through this process include:

  • disputed claims service provider work capacity decisions (including PIAWE) issued under a section 43 or 78 notice
  • disputed claims service provider decisions issued under a section 78 notice.

icare will also action applications for insurer reviews received from employers who dispute claims service provider decisions on these issues.

icare will work closely with claims service providers and our customers to ensure:

  • unnecessary disputes are resolved
  • customers receive the right level of support, information and advice. 

Litigation process

Claims service providers are responsible for managing disputes that are lodged with the Personal Injury Commission for resolution (litigated disputes).

The Commission is an independent statutory tribunal within the state's justice system that provides a transparent and independent dispute resolution service.

The claims service providers responsibility includes seeking legal advice before litigation is commenced, responding to and managing most litigated matters and engaging legal service providers to represent the interests of icare on behalf of employers before the Commission.

Where litigation is identified as significant, icare will either collaborate closely with, or assume responsibility for management of the process from claims service providers.

Significant legal matters includes those matters identified as having potential to have a long-term impact to the scheme, high expected monetary settlement costs and other novel or complex legal matters. 

Pathway for complaints and unresolved enquiries

If you have a complaint, you are encouraged to contact your claims manager in the first instance. Alternatively, you can call the icare Complaints Resolution Team on 13 99 22

From 1 January 2019, if you are still not satisfied that your complaint or enquiry has been resolved:

  • Workers with enquiries/complaints about their insurer should contact IRO on 13 94 76  
  • Workers with enquiries/complaints about their employer or provider should contact SIRA on 13 10 50  
  • Employers and other stakeholders with enquiries/complaints should contact SIRA on 13 10 50 

The icare Complaints Resolutions Team provides support in respect of complaints and enquiries relating to claims. Contact 13 99 22 or lodge a complaint.

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