How to lodge a dispute about a decision on your workers compensation claim
When disputes happen, there is help available to have it resolved.
Complaints and unresolved queries
A complaint is any expression of dissatisfaction made in relation to an organisation’s products, service or the complaints handling process where a response or resolution is implied.
A complaint can relate to the conduct of the insurer, employer or provider.
We encourage all injured workers to try and resolve disagreements directly with their employer or insurer before deciding to escalate to a formal dispute process, should you still wish to.
If you’re unable to reach a mutually agreeable outcome, you may contact:
- the icare Complaints Resolutions Team who may provide support in respect of complaints and enquiries relating to claims on 13 99 22 or Complaints or
- the State Insurance Regulatory Authority (SIRA) on 13 10 50 if your enquiry or complaint is about your employer or provider; or
- the Independent Review Office (IRO) on 13 94 76 if your enquiry/complaint is about your insurer.
Disputes between you and your insurer
A workers compensation dispute may arise when an insurer fails to determine a claim or makes a decision on a compensation claim that you disagree with.
On 1 January 2019, an improved workers compensation dispute resolution system commenced. The Workers Compensation Commission (WCC) is now 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).
Some examples of disputes include:
- work capacity decisions (More information about work capacity decisions can be found on the SIRA website)
- weekly payments compensation
- suitable work following a work injury
- medical, hospital and related expenses
- permanent impairment compensation
- pain and suffering compensation
- compensation for damage to personal property
- compensation for domestic assistance
- degree of permanent impairment.
If the insurer makes a decision you don’t agree with about one of these areas, you can first request an internal review by your insurer (who must respond within 14 days of receipt). Alternatively, you can lodge a dispute directly with the PIC.
Disputes between you and your employer
Disputes that happen between injured workers and employers generally relate to injury management, and they follow a similar process to other types of disputes:
- If your employer has made a decision about your injury management that you don’t agree with, you can request assistance from the insurer managing your claim to help resolve it.
- The insurer may resolve the dispute, or appoint a consultant to assist you.
- If you’re still unhappy with the result, you may then lodge a dispute with the PIC.