Workers compensation disputes

The worker, the insurer or the employer can apply for an expedited assessment. There are several situations where an expedited assessment may be suitable:

1. The worker:
   • has not received a decision about their claim from the insurer, and
   • the period of incapacity for work is up to 12 weeks or the amount of compensation for medical expenses is not more than $9,722.
2. The worker:
   • has received a notice from the insurer stating that the worker’s claim has not been accepted, and
   • the period of incapacity for work is for up to 12 weeks or the amount of compensation for medical expenses is not more than $9,722.
3. The worker:
   • has received a letter from the insurer stating that the claim has been accepted but the worker disagrees with the amount of compensation payable, and
   • the period of incapacity for work is for up to 12 weeks or the amount of compensation for medical expenses is not more than $9,722.
4. The worker has received notice from the insurer of a work capacity decision and the worker disputes that decision.
5. The worker and the employer cannot agree on an injury management plan and/or aspects of the worker’s return to work (a workplace injury management dispute).

In some circumstances, the Commission may decide that a dispute is not suitable for the expedited assessments pathway and it may be reassigned to the legal disputes pathway.

Before lodging a dispute with the Commission, a worker must have first submitted a claim on their employer or their employer’s workers compensation insurer.

Workers who disagree with all or part of the insurer’s decision have the right to request a review by the insurer before lodging an application with the Commission.

The person or party lodging the application is called the applicant. The person or party responding to the dispute application is called the respondent.

The Commission cannot resolve all workers compensation disputes because the law requires some classes of workers to seek assistance with their claims from other agencies responsible for their administration. These classes of workers include coal miners, volunteer rescue workers and workers who suffer specified dust-related conditions.

Lodging the Application for expedited assessment (Form 1) is the first step for the applicant to apply to have a dispute about weekly compensation and/or medical expenses compensation resolved by the Commission through the expedited assessments pathway.

Lodging the Application to resolve a workplace injury management dispute (Form 6) is the first step for the applicant to apply to have a dispute about workplace injury management resolved by the Commission.

Most applicants are legally represented, with the application being lodged by the legal representative on their behalf. The application can only be lodged through the Commission’s digital platform, Pathway.

As a preliminary conference will be booked 14 days from the date the application is accepted by the Commission, applicants must ensure they are available to participate two weeks after the lodgment date. Preliminary conference dates are not usually changed, so it may be best to delay lodgment, if needed, until the applicant and their legal representative are available. All parties will be notified of the date and time of the preliminary conference by the Commission.

All supporting documents must be lodged as a single document bundle that is indexed, sorted by document category, paginated and does not contain any duplicate material.

An application should not be lodged until all relevant material is available because it may not be possible to include further information later in the dispute resolution process.

At the same time as lodging the application and relevant information, the worker or their legal representative must also serve a copy on the employer or their insurer. The Commission does not return copies of the application after registration.

The next step in the lodgment process is for the respondent or their legal representative to respond to the application by lodging a Reply to application for expedited assessment (Form 1B) or to respond to the application to resolve a workplace injury management dispute by lodging a Reply to an application to resolve an injury management dispute (form 6B).

Most respondents are legally represented and the reply is lodged by the legal representative on their behalf. The reply can only be lodged through the Commission’s digital platform, Pathway.

At the same time as lodging the reply, a copy is required to be served on the worker or their legal representative. The Commission does not return copies of the reply after registration.

The application will proceed even if the respondent chooses not to lodge a reply or does not respond in the required time, which is three days before the date of preliminary conference.

All information relevant to the dispute which is not attached to the application must be attached to the reply and provided to the other party as it may not be possible to include further information later in the dispute resolution process.

All supporting documents must be lodged as a single document bundle that is indexed, sorted by document category, paginated and does not contain any duplicate material.

The time taken to resolve a dispute depends on:

• the issues in dispute
• the standard of preparation by the parties
• the willingness of parties to genuinely attempt resolution
• whether a decision is reviewed.

The Commission aims to resolve disputes as quickly as possible and will encourage the parties to resolve their dispute at the earliest opportunity.