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Your right to challenge a WorkCover decision

Published on 19 July 202217 January 2023

Please note that this post was written for Queensland audiences and the information within may not apply to other regions.

Dealing with all that a work-related injury comes with is tough, let alone if your WorkCover claim is rejected or a condition is changed. But what can you do if this happens?

WorkCover is responsible for making all the decisions regarding your claim: about your weekly payments, medical expenses, or permanent impairment benefit. Those decisions aren’t always in your favour. The good news is, you don’t have to agree with it.

Workers are often shocked when WorkCover stops paying their weekly benefits, gives them a low permanent impairment rating, or refuses to fund a medical procedure. And they don’t realise that any decision made by the insurer is open to dispute.

Whether WorkCover decided to end your payments, offered you an unfair permanent injury lump sum or outright denied your claim, and you don’t think it’s fair, you have the right to challenge the decision.

How to dispute a WorkCover decision

No matter what kind of decision WorkCover made that you don’t agree with, it’s the same process to appeal it – but you only have three months of being advised of the decision to get it started.

Firstly, when WorkCover advise you of a decision regarding your claim they should provide you with a decision document that outlines their reasons. If they don’t, you have 20 days to ask for one to find out why. Then, you have three months to lodge an application for the review.

The Workers’ Compensation Regulator is the entity responsible for reviewing WorkCover insurer decisions in Queensland. They are an independent party separate from WorkCover Queensland, ensuring all case reviews are done fairly and unbiasedly.

When you submit your review, you’ll generally be required to explain why you think WorkCover’s decision is wrong and provide supporting documents (including medical reports, witness statements, photos etc.). The regulator then has 25 business days to decide the outcome.

What decisions are reviewable?

As touched on above, most WorkCover decisions are reviewable. Section 540 of the Workers Compensation and Rehabilitation Act 2003 lists a few including:

Whether to accept or deny an application for compensation
An increase, decrease, termination or suspension of payments
When the insurer fails to make a decision about the application
A decision about the timeframe of the application (including if you submitted it too late)

What if WorkCover doesn’t change its mind? Can I appeal a WorkCover review?

More often than not (in fact, 60 per cent of the time), the regulator will uphold the original WorkCover decision because you might not have enough evidence to prove otherwise.

This may feel like another setback, but it is also possible to appeal the review decision if you still don’t agree. However, you can only do this once, and that decision stands.

You can appeal a WorkCover review through the Queensland Industrial Relations Commission. This must be done within 20 business days, and you must provide a copy of the notice to the regulator within 10 business days.

Note: Your employer is also entitled to appeal a WorkCover decision and review if they don’t agree with it.