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, we encourage you to get in touch with the Workers Compensation Independent Review Office (WIRO) or the State Insurance Regulatory Authority (SIRA). They can provide you with information and support about the dispute resolution process.
All workers compensation disputes (except work capacity disputes) are dealt with by the Worker’s Compensation Commission (WCC).
Disputes between you and your insurer
The following types of disputes generally occur between an injured worker and the insurer managing your claim:
- medical, hospital and rehabilitation
- permanent impairment
- work capacity.
If the insurer makes a decision you don’t agree with about one of these areas, you can first request an internal review by the insurer.
If you’re not satisfied with the outcome of an internal review, you can request a review by one of two external panels.
Disputes about liability, your medical, hospital and rehabilitation needs or permanent impairment assessments are escalated to the Workers Compensation Commission (WCC).
Disputes about work capacity are escalated to the State Insurance Regulatory Authority (SIRA) and then Workers Compensation Independent Review Office (WIRO) if you are dissatisfied with SIRA’s response.
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 WCC.
Managing your legal costs
You can seek assistance from a legal practitioner regarding an application for merit review by SIRA.
The insurer is liable to pay costs for advice given in relation to an application or proposed application for merit review of the original work capacity decision made by the insurer from 16 December 2016.
Legal costs will not be payable if you seek legal advice more than 30 days after you were notified of the internal review decision.
Administrative law challenges
All merit reviews by SIRA are subject to administrative law judicial review in the NSW Supreme Court.