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The WorkCover Compensation Independent Review Service (WCIRS): An Additional Dispute Resolution Option for Injured Workers

In 2020, WorkSafe Victoria established the Workers Compensation Independent Review Service (WCIRS) to review decisions of the WorkSafe Insurer that remained unresolved after Conciliation.

The Service was established in response to a recommendation by the Victorian Ombudsman following their investigation into the management of complex workers compensation claims.

WCIRS provides an additional avenue for injured workers to seek review of decisions made by their WorkCover insurer.

WorkSafe have stated that the purpose of the service is to make “workers feel understood and supported through the review process”.

When can a Decision be Reviewed?

If your matter has been referred to the Workplace Injury Commission (formerly known as Conciliation) and has not been resolved, the Conciliator will issue a Genuine Dispute Certificate (GD). You then have 2 years from the date of the GD to have your matter referred to WCIRS.

WCIRS can only look at a “reviewable decision” this includes decisions in relation to:

Provisional payments

Medical and like expenses

Decisions related to claim acceptance

Decisions related to weekly payments.

It does not include decisions in respect of:

the degree of impairment

Serious Injury Applications or Common Law Damages Applications

final Medical Panel determinations

the details of a whether a person is a worker or their dependents

Decisions made by or on behalf of a self-insurer

Further information about the process and an online application form can be found here.

What will WCIRS consider?

WCIRCs will have regard to the medical and other documentation on your file to determine whether the decision that has been made is fair, reasonable and impartial. It is also possible for you to provide additional material in support of the review application.

In considering whether a decision is sustainable, WCIRS looks at:

The insurer’s decision-making process (including what has happened in relation to the claim)

The notice given to the worker of the insurer’s decision (and whether there are any practical impacts of the decision on the worker’s recovery and/or return to work)

The worker’s direct feedback about what has occurred and why they feel that the decision is not right

What happened at the Conciliation Conference

The impact and use of any new information in relation to the decision

Outcome and Timeframe for Review Process

WIRCS will generally attempt to provide their decision within a few months of receiving the application.

The worker will be notified in writing of the outcome of the matter.

If WCIRS determine that the decision was:

Not fairly or reasonably made in accordance with the relevant law

Not based on the available information

Not clearly communicated or properly explained (including the reasons for the decision)

Not considered to be a position maintained by a Court

WCIRS can refer the matter back to the insurer and may direct them to make a new decision.

If WCIRS overturned the decision, the insurer will be obliged to comply. This may result in benefits may be payable within a required timeframe.

If the decision is not overturned by the WCIRS, the worker may still issue court proceedings if they wish to persist with an appeal of the decision.

Conclusion

We understand that over the last 12 months the WCIRS has overturned about 36% of the decisions which it has reviewed. On this basis, making an application may very well result in a change in the decision.

WorkSafe also monitor the review decisions and use this information to assist in training insurers which it is hoped will lead to better decisions at first instance.

Stringer Clark has generally found the review process to be prompt and the decisions to be well reasoned.

We are certainly pleased that this service has been introduced, as it provides an additional option for injured workers to seek timely and free review of claim decisions.

There are many factors to consider in determining whether a WCIRS application is the best option for you. We therefore encourage you to contact us for further advice on (03) 9238 7878.