Who handles dispute resolution for NSW workers compensation claims?

Published 16 Apr 2018

Workers compensation is an essential safeguard in Australia that enables employees to perform their jobs without the fear of a workplace injury or illness leaving them financially in trouble.

But claims aren't always approved, which can cause people further stress at an already difficult time. Fortunately, dispute resolution services are available in NSW to help employees have their case reassessed.

So who handles your claim if you're not happy with the result? Here's a breakdown of the relevant organisations.

The insurer

The first step in the process is contacting the insurer that rejected your claim and asking for an internal review of its decision. Make sure you provide as much additional information as possible to support your case.

Insurers are required to respond with a new decision to your request within 14 days, which will either confirm or overturn the previous ruling.

The State Insurance Regulatory Authority (SIRA)

You can contact SIRA to perform a merit-based review of work capacity decisions. In other words, the authority can assess whether or not an insurer was correct when gauging your ability to work or judging your entitlement to receive workers compensation payments.

The results are binding on the insurer and should arrive within 30 days of you lodging a merit review request.

The Workers Compensation Independent Review Office (WIRO)

If you are still unhappy with a work capacity decision, you can ask WIRO for a procedural review. This examines the processes the insurer used when deciding on your workers compensation claim.

Any procedural errors can lead WIRO to set aside the insurer's ruling and recommend the next steps, such as suggesting a new work capacity decision.

The Workers Compensation Commission (WCC)

Not all workers compensation disputes involve work capacity complaints. The WCC instead handles arguments over liability and medical issues.

Liability disputes may arise when an insurer doesn't believe the claimant is classed as a worker in line with legislation or feels the individual's employment didn't contribute to the injury. On the other hand, medical disputes can relate to whether or not a disability is permanent and similar matters. 

Workers compensation lawyers

The dispute resolution system in NSW can be complex, with a number of different organisations handling key elements of workers compensation claims.

An experienced personal injury lawyer can help you navigate dispute resolution and ensure you receive the compensation to which you are entitled.

Contact Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers to discuss your workers compensation claim today.