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, established in early 2018, is responsible for conducting internal reviews of liability and work capacity decisions made by EML (for claims lodged on or after 1 January 2018) and by Allianz (for claims lodged on or after 1 July 2018) when a request for review of a decision is made by the worker or employer.
The icare Litigation Team has oversight over significant legal matters on behalf of the Nominal Insurer and manages litigation on behalf of EML (on claims lodged on or after 1 January 2018) and Allianz (for claims lodged on or after 1 July 2018).
This team is responsible for developing litigation strategies when a matter proceeds to litigation, assessment of matters for referral to external legal providers and liaison between the legal providers and EML and Allianz.
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.