Types of workers insurance disputes
If you think your insurer has got something wrong, you can ask for a review of the decision.
When you’ve been injured at work, there are many decisions that need to be made by both your employer and the insurer when you make a claim.
If you don’t agree with a decision at any point along the journey, you can raise it directly with them.
For a fast and cost-effective resolution, we encourage you to try and resolve disagreements with your employer or insurer directly.
But if you can’t resolve the issue, there are a range of ways you can lodge a dispute. You can lodge a dispute about:
- liability
- permanent impairment
- injury management
- medical, hospital and rehabilitation.
Improving dispute resolution
On 4 May 2018 the NSW Government announced plans to reform the dispute resolution process for workers compensation to make it easier to resolve disagreements earlier.
With the launch of the new claims model, icare and EML have taken the lead on this transformation and made changes on how disputes are managed on new claims lodged on or after 1 January 2018.
Under these changes, icare plays a more active role in overseeing and managing disputes in their early stages. The changes are designed to allow faster resolution of disputes and a better experience for both employers and workers.
What is a dispute?
A dispute arises when there is a disagreement with an insurer’s decision on a claim. It is important to note, there is a difference between a complaint and a dispute, and a separate, independent pathway exists for employers and workers to express how they feel about a situation or seek guidance.
Who manages disputes on claims lodged on or after 1 January 2018?
icare has established a new Dispute Resolution team in Workers Insurance to help resolve disagreements about decisions made by EML on claims lodged on or after 1 January 2018.
This team is independent of the original decision and have decision making rights.
They will work closely with employers and workers to resolve disagreements with decisions made by EML affecting an entitlement to benefits (compensation, liability and work capacity disputes).
- Compensation and liability disputes
- Work capacity disputes
When can a disputes application be lodged?
What will happen when a disputes application is lodged?
A Dispute Resolution Specialist will be allocated and all parties to the dispute will be:
- notified that a disputes application has been received;
- provided with a step-by-step guide of the review process - including what they need to, by when and why;
- given the opportunity to send in any relevant information they would like to be considered: and
- informed of the review outcome.
This review mechanism is unique to the new claims model and highlights icare’s commitment to greater transparency and engagement with all NSW workers compensation customers.
What other support services are available to Employers?
- General queries or complaints about a claim should be first raised with your claims service provider. If you're dissatisfied with their response, call icare on 13 99 22 or email wiclaimsenquiries@icare.nsw.gov.au.
- Contact SIRA for general enquiries or complaints about the regulation of workers compensation in NSW.
- Contact IRO at any time for help.