How to dispute a decision about your treatment and care needs

As a participant with icare lifetime care, you have the right to disagree with any decision that we make about your treatment and care needs.

If you don’t agree with a decision we’ve made about your treatment and care needs, the first step is to discuss it with your case manager and coordinator.

We are committed to helping you resolve issues quickly and informally.

We may contact others involved in your care, such as your service providers or family and carers and arrange a meeting to discuss the decision.

You can also contact our Assessment Review Team on 1300 738 586 to discuss your concerns.

Lodging a dispute if you are still unhappy

If we cannot resolve things informally, you can also lodge a dispute.

A dispute can only be lodged about a decision we have made about your treatment and care needs and notified to you in writing on a certificate.

It will then be reviewed by an independent dispute assessor.

What you'll need to know about lodging a dispute

  1. Who can lodge a dispute
    A dispute can be lodged by either by you or your representative. A representative can include a family member, solicitor or advocate.
  2. How to lodge a dispute

    A dispute must be lodged in writing – in a letter or email to us, explaining why you disagree with the decision.

    You should include any information that is relevant to the dispute

    It must be lodged within 28 days of receiving the certificate with our decision.

    To find out more, contact us.

    We also have a support and advocacy service who can assist you to navigate our dispute process.  See our advocacy page for more information on accessing this service.

  3. Dispute assessment process

    We will choose a dispute assessor who can best resolve your dispute. It will be an independent professional who has not assessed or treated you before.

    All treatment and care needs dispute assessors are medical and health professionals and have extensive experience working with people with severe injuries.

     

    The dispute assessor will be sent all relevant information on the dispute and will then decide how to assess the dispute.

     

    They may decide to assess you and talk to the people involved in your life (such as family members or treating health team).

     

    Once the assessment is completed, the assessor will make a decision. This decision is legally binding, which means you and icare lifetime care have to accept the decision. You are able to request a review of this decision, based on certain grounds in the legislation.

  4. Providing information to the dispute assessor

    You or your representative can give information to the dispute assessor.

     

    This should be in writing and sent to icare lifetime care Assessment Review Team.

     

    It’s important to provide any relevant information as soon as possible to ensure the dispute assessor reviews it, as it may impact how they assess the dispute.


    We’ll send the information to the dispute assessor and to any other parties involved in the dispute.


    You’ll also be sent a copy of any information provided by another party.

  5. Length of dispute process
    Disputes about treatment and care needs may take several months to resolve, because of the time required to gather information or to complete assessments to ensure the right decision is made.
  6. What happens next

    You’ll receive the dispute assessor’s decision in writing in a certificate, which will include reasons for the decision. It will be sent to you and to icare lifetime care at the same time.

    This decision is legally binding, and can only be reviewed on certain grounds, as outlined below.

    For more information, contact us.

    What happens if you don't agree with a dispute assessor's decision

  • Requesting a review of a dispute assessors decision
    If you think the dispute assessor’s decision is wrong, you can request a review by a formal review panel.

    You can only apply for a review if one or more of the following applies:
    • There is additional relevant information about your treatment and care needs (information that was not available, or could not reasonably have been obtained, at the time of the assessor’s determination and that information is capable of having a material effect on the determination)
    • The decision was not made in accordance with the Lifetime Care and Support Guidelines.
    • The decision is demonstrably incorrect in a material respect.
  • How to apply for a review

    If you apply for a review, icare lifetime care can make submissions on the application.

    The application, any submissions received in response, and all relevant will be considered in determining whether the application should be referred to a review panel. The decision will be made within 10 days during which time, you may be contacted for additional information.

    Within five days of the decision being made, you will be advised as to whether the application will be referred to a Review Panel, or rejected.

    Written reasons will be provided.

  • Who is on the review panel

    If your review application is accepted, a review panel of three suitable assessors from our list of dispute assessors (not including the original assessor) will be convened as soon as possible.

    You’ll be advised of the arrangements for the review panel, including their names and specialties.

    Within 10 days of receiving this advice, you can request different assessors if any of the panel members are unsuitable. Both of us (yourself and icare lifetime care) can make a submission.

    If necessary or appropriate, different assessors will be allocated to the panel.

    When the review panel convenes, a panel chairperson will be appointed and all three assessors will be sent all information including documents from the previous assessor, and anything provided from us or you since then.

    The initial meeting will be held within 30 days of when the panel has been convened.

  • How the panel will asses your review

    The review panel will determine how it will conduct the assessment, but must comply with the Lifetime Care and Support Scheme Guidelines.

    The panel will consider all aspects of the dispute, and decide whether new information or a clinical examination is needed.

    You must comply with any reasonable request from the review panel, including undergoing a clinical examination if needed. 

  • Length of review process

    The review may take several months to finalise.

    It may take longer if all relevant information is not provided with the application.

  • What happens next

    The panel will either confirm or revoke the decision of the dispute assessor. If the decision is revoked, the panel will substitute its own determination.

    The panel will issue a certificate with written reasons for their decision within 20 days of their last meeting. This will be sent to you and to icare lifetime care.

    The decision is final and binding.

    The cost of the review panel assessment (including any necessary travel and accommodation) is paid for by us.

    But we cannot pay any legal costs for you or other parties (for example, if you engage a solicitor to assist you with the review). For more information, contact us.