Workers compensation helps Australians receive financial support when they are injured or become ill due to an employment-related incident.
These payments can prove crucial to many families when their main income stream is unexpectedly stopped.
There were 107,355 serious workers compensation claims lodged in 2014-15, according to Safe Work Australia. Serious claims refer to incidents where an accepted injury or illness resulted in absence from the workplace for at least one week.
Unfortunately, insurers don’t always approve workers compensation claims, which can leave people struggling to pay their day-to-day expenses.
Dispute resolutions services are available to help rejected claimants challenge a previous decision, but a new government report has found many individuals believe the process is confusing and inadequate.
How does the current system work?
There are two primary pathways in the dispute resolution system:
- Work capacity decisions; and
- Liability and medical disputes.
Employees who are receiving workers compensation are regularly reviewed to see whether they are capable of returning to their job. If an individual disagrees with an assessment, they can pursue a work capacity decision dispute.
The insurer often then performs a new evaluation, but the employee can also seek a second opinion from the State Insurance Regulatory Authority (SIRA) or the Workers Compensation Independent Review Office (WIRO). Employees can also turn to a judicial review at the Supreme Court if they are still unhappy.
Meanwhile, the Workers Compensation Commission (WCC) handles liability and medical disputes, such as evaluating an individual’s level of permanent impairment from an injury and deciding who is responsible for payments.
Why are claimants dissatisfied?
A WIRO discussion paper, published in December, uncovered a number of problems with the current dispute resolution service.
Claimants said the system is:
- Difficult to understand and access;
- Highly adversarial due to aggressive insurers;
- Lacking in support materials; and
- Exhausting for workers who are already suffering from injuries and illnesses.
The discussion paper offers a number of options for dispute resolution reform. Many of the proposed models look to introduce a one-stop-shop approach, simplifying the process by reducing the number of organisations responsible for claims.
“The presence of multiple dispute resolution bodies, often with overlapping or poorly understood functions, is a major source of frustration among injured workers, employers and scheme providers,” added Minister for Finance, Services and Property Victor Dominello.
The NSW government is currently accepting submissions from stakeholders regarding dispute resolution reforms. The deadline to submit proposals is February 20.
However, if you’re struggling to navigate the workers compensation system in the state, please contact a member of our team at Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers.