On 30 April 2020, WorkSafe Victoria established the Workers’ Compensation Independent Review Service (WCIRS). The purpose of the WCIRS is to review decisions made by insurers with respect to workers’ compensation claims. When undertaking a review, the WCIRS must determine whether a decision made by an insurer is sustainable or has a reasonable prospect of Defence at Court. You are allowed to issue Court proceedings and make an application to the WCIRS at the same time.
Can I request an independent review?
To make an application to the WCIRS you must first go through the Conciliation process with the Accident Compensation Conciliation Service and obtain a Genuine Dispute Outcome Certificate. The following criteria must also apply:
The decision by the insurer was made on or after 3 December 2019;
The application for independent review was made within two years of the date of the Genuine Dispute Outcome Certificate; and
The application must be made prior to the Victorian Magistrates’ or County Court –
Listing court proceedings for a final hearing date; or
Referring a medical question to a Medical Panel for assessment.
What decisions can be reviewed?
Only decisions deemed reviewable by WorkSafe Victoria can be the subject of a review by the WCIRS. Reviewable decisions by an insurer include:
1) Decisions to reject a WorkCover claim for weekly payments and/or medical and like expenses;
2) Decisions to suspend or refuse to reinstate or terminate weekly payments and/or medical and like expenses; and
3) Decisions regarding the calculation of a worker’s Pre-Injury Average Weekly Earnings.
The above list is not exhaustive and the WCIRS has a wide discretion to accept other decisions for review.
What decisions are not reviewable?
Some decisions are not capable of review by the WCIRS. These decisions include:
1) Decisions with respect to worker’s degree of impairment;
2) Decisions relating to the death of a worker or dependents of a deceased worker;
3) Decisions which rely on a medical panel determination;
4) Decisions where the worker and insurer have entered into an agreement or settlement as part of a Conciliation conference;
5) Decisions made by authorised self-insurers; and
6) Decisions regarding a Serious Injury Application or Common Law Damages claim.
Lodgement and Outcomes
Once you have lodged an application with the WCIRS, the Independent Review Officer (IRO) allocated to the review must provide a formal response to your application within 28 days. The IRO may contact you or your authorised legal representative for further information throughout the review process. Within 28 days of making the application, the IRO must provide formal review findings which confirm whether the WCIRS is going to confirm or overturn the decision by the insurer. The review findings must be communicated to both the worker and the insurer. If the decision is overturned, the insurer, within two days, must take steps to give effect to the overturned decision.
We have a team of WorkCover lawyers who have had significant experience in using the WCIRS for many of our clients, including a number who have been successful at overturning the insurers’ decisions to reject or terminate their entitlements.
If you, or someone you know, would like further information about the WCIRS and whether it is right for your claim, please contact our office on 03 8527 0200 for an obligation free telephone appointment to speak to one of our expert WorkCover lawyers.