Card 05 · If the claim is disputed
When a workers compensation claim is disputed
If the insurer refuses your claim, or cuts or stops a payment, you can challenge the decision, usually first with the insurer and then through an independent body that conciliates and, if needed, decides. Every scheme names a different body and sets different time limits, and some of those limits are short.
General information, not legal advice. Most time limits run from the date you receive a decision. Time limits can be short; the body named for your state can tell you how one applies to you. Each body’s own page is linked below.
Before the first step
- Get the decision, and its reasons, in writing. In Queensland you may be able to ask the insurer for a reasons-for-decision document within 20 business days of being told of the decision.
- Write down the date the decision reached you.
- Ask the insurer to look at it again, where your scheme allows. In NSW, some disputes need an internal review by the insurer before the Personal Injury Commission will take them. NT insurers should complete their internal review in no more than five working days.
- Gather what supports your side: certificates, reports, payslips, letters.
The ladder in each state
Read across a row: the first independent step, what comes after it, and the clock the body itself publishes.
| Where | First independent step | Then | Clock |
|---|---|---|---|
| NSW | Independent Review Office for complaints about insurers; Personal Injury Commission for disputes | If the parties can’t reach their own resolution, an independent decision maker of the Commission decides | Varies by dispute type; see the Commission |
| VIC | Conciliation at the Workplace Injury Commission | Arbitration, or court, with a Genuine Dispute Certificate | Apply within 60 days of the decision; late applications need a reason |
| QLD | Review by the Office of Industrial Relations | Appeal to the Queensland Industrial Relations Commission | Review within 3 months of the written decision; appeal within 20 business days of the review decision |
| WA | WorkCover WA’s Conciliation Service | Arbitration Service, after a Certificate of Outcome | 21 days to apply if payments are to be cut on medical evidence |
| SA | South Australian Employment Tribunal | Conciliation, settlement conference or a hearing | One month after notice of the decision |
| TAS | Tasmanian Civil and Administrative Tribunal, mostly by conciliation | An arbitrated hearing if conciliation fails | Ask the Tribunal for its forms |
| ACT | Conciliation, which must come before arbitration | Arbitration | Written details to the other parties at least seven days before conciliation |
| NT | Mediation through NT WorkSafe, free to the worker | The Work Health Court | 90 days from receiving the insurer’s notice of decision to apply for mediation (rejection, reduction or cancellation); 28 days to go to court after the certificate of mediation, which the Court can extend |
| Cth | A review of the decision by Comcare | The Administrative Review Tribunal | See Comcare’s page |
What each step is like
New South Wales
Legal Aid NSW describes the Independent Review Office as an independent body that deals with injured workers’ complaints about insurers, including weekly benefits, medical treatment, denials of liability and delays. Disputes are lodged with the Personal Injury Commission through its online Pathway Portal, after a claim has been made with the insurer. The Commission’s dispute resolution services, including medical assessments, are free, and it can arrange interpreters at no cost. Most parties are entitled to government funding for legal help through ILARS, described in choosing a lawyer.
Victoria
The Workplace Injury Commission is a free, informal conciliation service, independent of WorkSafe, agents, employers, solicitors and unions. You can apply if you disagree with a decision, or if an agent or self-insurer hasn’t responded or paid within a reasonable time. A conciliation officer can recommend a resolution, direct payments, or refer a medical question to a Medical Panel, whose opinion is binding. If it isn’t resolved, a Genuine Dispute Certificate opens the way to arbitration, for eligible disputes about injuries from 1 September 2022, or to court; at arbitration an arbitration officer makes a final, binding decision. If conciliation doesn’t resolve it, WorkSafe says you may also be able to ask the Workers’ Compensation Independent Review Service for a review.
Queensland
The review is not a court process. A review officer looks at the documents already available and doesn’t re-investigate the claim. Reviewable decisions include accepting or rejecting a claim, changing weekly payments, and an insurer failing to decide. If you engage a solicitor for an appeal, you cover that cost yourself.
Western Australia
Disputes go to WorkCover WA’s Conciliation Service, and its Advice and Assistance Service on 1300 794 744 can help. Arbitration is available only after conciliation ends with a Certificate of Outcome. If your employer gives notice that it will cut or stop income compensation on medical evidence, applying to the Conciliation and Arbitration Services within 21 days keeps payments going until the dispute is finalised.
South Australia
ReturnToWorkSA encourages you to talk to your case manager first; formal review is through the South Australian Employment Tribunal. Lodging is free, and Registry staff can help with the form but can’t give legal advice. Once you lodge, the compensating authority has 10 business days to reconsider and confirm or vary its decision.
Tasmania
Disagreements with an employer’s decision, such as the start, amount, reduction or end of weekly payments, can be referred to the Tasmanian Civil and Administrative Tribunal. It deals with most through conciliation and holds an arbitrated hearing if that fails.
Australian Capital Territory
Conciliation must happen before arbitration, and everyone involved must attend and make a genuine effort to agree. WorkSafe ACT warns that at arbitration the insurer isn’t liable for costs as it is at conciliation, which could mean heavy costs.
Northern Territory
Mediation is mandatory before the Work Health Court. A mediator is appointed within seven days of a written request and has 21 days to work through it. You can bring a support person who isn’t a lawyer, and NT WorkSafe’s compensation section on 1800 250 713 can help with the application.