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 disputesFrom 1 January 2019 the Workers Compensation Commission (WCC) is the central body for resolving all workers compensation disputes.
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 WCC.
icare encourages workers to seek to resolve the dispute early, directly with the insurer.
icare’s role in the dispute process
Dispute Resolution TeamThe icare Dispute Resolution Team is responsible for conducting internal reviews of liability and work capacity decisions made under icare’s Service Model by EML and Allianz when a request for an insurer review is made by the worker or employer.
The icare Litigation Team has oversight over significant legal matters on behalf of the Nominal Insurer and is responsible for all litigation on behalf of EML and Allianz on claims managed under icare’s Service Model.
This includes the assessment of matters for referral to external legal providers, liaison between the legal providers and EML and Allianz, the development of litigation strategies and instructions on matters that proceed to litigation.
Pathway for complaints and unresolved enquiriesIf 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 WIRO 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.