Once an injured worker receives a notice from the insurer to decline liability or reduce the amount of weekly benefit, they can:
1. Accept the decision
2. Contact WorkCover’s Claims Assistance Service, union or legal representative for advice
If an injured worker requires any assistance in relation to the notice they can contact WorkCover’s Claims Assistance Service on 13 10 50, their union or a legal representative.
3. Disagree with the decision and request that the insurer conduct a further review of the decision
Attached to the dispute notice will be an application form for the injured worker or their representative to complete. On the application form the injured worker should explain why they are requesting the review attaching any additional information that they think is relevant to the decision.
The insurer is required to respond back to the worker in writing within 14 days of receiving the request for a review. The insurer will either decide to accept the claim or maintain their decision and issue a revised notice, with any additional information relevant to the decision.
If a dispute is lodged in the Workers Compensation Commission the parties can only rely on information included with the dispute notice or application for review. Therefore it is important for an injured worker to attach all relevant information at the review stage as they will be precluded from introducing new material after an application has been lodged at the Workers Compensation Commission.
There may be instances when an insurer inadvertently fails to attach all relevant documents or communicate everything they are required to in the notice. The insurer has an obligation to remedy any defective dispute notices as soon as they become aware of the defect. In the first instance, the injured worker should contact the insurer and ask them to remedy the defect. If they do not, then the injured worker can contact WorkCover’s Claims Assistance Service on 13 10 50 or ask their union or legal representative to assist them.
4. Lodge an application with the Workers Compensation Commission
If the worker is satisfied that the insurer has considered all of the relevant issues in making their decision to decline the claim and they disagree with the merits of the decision they can choose to lodge an application to dispute the decision with the Workers Compensation Commission.
The Workers Compensation Commission provides detailed information on resolving disputes or you can call WorkCover’s Claims Assistance Service on 13 10 50 for more information.