Injured workers receiving weekly entitlements are exposed, throughout the life of their claim, to a potential work capacity decision made by the insurance company at any time. Work capacity decisions relate to whether you can work, the type of work you can do, and for how long. The scope of a work capacity decision is governed by section 43 of the Workers Compensation Act 1987.

Examples of typical disputes include:

  • You disagree with the insurer on your current ability to return to work;
  • You disagree with the insurer as to what is suitable employment for you during your recovery period;
  • You disagree with the monetary amount you are able to earn in suitable employment;
  • You disagree with the amount that has been assessed by the insurer for your preinjury average weekly earnings or current weekly earnings;
  • You disagree with the insurer that you are able to engage in employment without causing further substantial risk of injury based on your injury.

The Workers Compensation Commission does not hold jurisdiction in relation to determining these matters, instead a different process applies.

A request for an internal review of the decision to the insurance company is required as the first step. The insurer then has 30 days to provide their review decision. If you still disagree with the insurer’s decision you can then apply for a merit review by the State Insurance Regulatory Authority (SIRA). As of 1 August 2016 you are now able to have a solicitor prepare this application. SIRA will conduct a merit review and then send the details of the findings and recommendations, with their reasons, to you and the insurer, usually within 30 days of the application being made. SIRA’s review is binding on the insurer.

If you disagree with the decision from SIRA then you can apply for a procedural review by the Workers Compensation Independent Review Office (WIRO). If you believe your workers compensation payments are not correct, please contact our office to meet with a solicitor to discuss your payments, because Helping You is Our Business.

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