Published: 15 March 2018
Disputing a WorkCover decision
When a WorkCover insurer such as CGU, Allianz, xChanging or EML make a decision in relation to your claim, whether it be about medical and like expenses, weekly payments or an impairment benefit, you always have the option of disputing the decision. Decisions are to be made in writing by the insurer, setting out what the decision is, why they have made the decision and your appeal rights in relation to it.
You may find sometimes that you never receive a written notice about a decision made by the insurer. However, you can still challenge a decision even if you have not been provided with written notice.
If you are notified by telephone and you never receive a follow-up written notice, we advise that you contact your claims manager to ask that they provide the decision in writing to you, along with your appeal rights.
What happens next
If you want to dispute a decision, you must fill out a request for conciliation form. You can get one of these forms at our office or from the Accident Compensation Conciliation Service (ACCS) website.
The ACCS is an independent body that will arrange a meeting, called a conciliation, where the insurer will tell you why they made the decision and you are able to respond as to why you disagree.
There are several different outcomes that can happen from there:
- the insurer may revoke their decision, or modify the decision in some way.
- the insurer may make an offer to you to resolve the dispute. For example, if your physiotherapy has been terminated, they may make an offer to you of a further 20 physiotherapy sessions. If you were to accept the offer, this would finalise your entitlement to physiotherapy after the 20 sessions had been used.
- there is no withdrawal of the decision or a variation or offers. In this case you either have the option of not taking the matter further, going to the Medical Panel or issuing court proceedings in the Magistrates’ Court.
By the time you get to this stage you should be seeking legal advice about what to do if you haven’t done so already.
If the decision relates to your entitlement to weekly payments it is essential that you get legal advice before proceeding further. We have seen a number of matters where unrepresented workers have finalised their entitlement to weekly payments at conciliation when clearly, they have had a strong claim to have their weekly payments reinstated and may have done themselves out of years of weekly payment entitlements.
As an example, a worker recently revealed that she resolved her entitlement to weekly payments at conciliation for about eight weeks of pay. My advice to her would have been to pursue the matter further and try and get her weekly payments reinstated, or at least secure an increase in the offer to 52 weeks or more. As a result of the agreement she reached, she could no longer get weekly payments, despite being unable to work on a long-term basis due to the injury.
The Ryan Carlisle Thomas team can help with your conciliation and WorkCover throughout regional Victoria.