Workers compensation disputes

Disputes are assigned to the most appropriate dispute resolution pathway.

Expedited assessments

Expedited assessments can provide quick results for all parties involved in a dispute. A teleconference is held 14 days from the date of lodgment of the application, and most disputes are resolved at the teleconference.

Expedited disputes are managed by a senior lawyer or Member from the Commission.

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Lodgment
Lodgment Teleconference Agreements and decisions Review of decisions

Lodgment

Applications for expedited assessment, and replies to those applications, may be lodged with the Commission.

When is an expedited assessment suitable?

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.

When to lodge an application

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.

How to lodge an application

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 online lodgment portal. More information about lodgment methods is available on our lodge a dispute page.

As a teleconference 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. Teleconference 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 teleconference by the Commission.

All relevant information must be attached to the application. 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.

How to respond to an application

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 online lodgment portal. More information about lodgment methods is available on our lodge a dispute page.

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 teleconference.

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. It may not be possible to include further information later in the dispute resolution process.

How long does resolving a dispute take

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.

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Teleconference

Most disputes in the expedited assessments pathway are resolved during the teleconference.

What to expect at a teleconference

Once an application for expedited assessment or an application to resolve an injury management dispute  has been accepted by the Commission, a teleconference will be scheduled 14 days from lodgment. The Commission will inform each party in writing of the time and date of the teleconference.

The teleconference is conducted by a senior lawyer  or Member from the Commission, who will have read all the evidence on which each party relies.

The teleconference may be attended by:

  • the worker
  • the worker’s legal representative
  • the insurer
  • the insurer’s legal representative
  • the worker’s employer, especially if the employer is a self-insurer
  • an interpreter, if needed.

Once all parties are connected to the teleconference, the senior lawyer or Member will introduce the parties and explain the process. The senior lawyer or Member  is required to use his or her best efforts to bring the parties to an agreed resolution.

The teleconference is scheduled to run for up to 90 minutes, although it often takes less time than that.

At any stage during the teleconference, there is a facility for either party to have a private conversation with their legal representative, even if they are not in the same location. The senior lawyer or Member will use the teleconference facilities to arrange this.

If a dispute is not resolved at the teleconference, the senior lawyer or Member will either seek further information (such as obtaining an assessment by an injury management consultant) or will decide the dispute and issue a decision. Decisions are issued to the parties within 14 days.

What happens during the teleconference

During the teleconference, the senior lawyer or Member will assist the parties to identify the issues in dispute and encourage them to reach an agreement about the dispute or part of the dispute. He or she will confirm:

  • that all parties understand the process
  • whether everyone agrees on the facts or issues in dispute
  • any legal or threshold  issues that must be decided

As the senior lawyer or Member is independent and impartial, they will not talk to any party unless all other parties are present.

Preparing for the teleconference

The parties involved in a teleconference will usually choose to participate from a quiet location where there are no distractions or background noise. Workers can participate from their home or they may prefer to attend their legal representative’s office to participate.

Only documents that have previously been lodged with the application, or the reply, can be referred to during the teleconference, unless permission is granted to allow the addition of further documents.

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Agreements and decisions

Disputes in the expedited assessments pathway are usually resolved by agreement between the parties, or the senior lawyer or Member will make a decision.

When an agreement is reached between the parties

If an agreement is reached at the teleconference, the senior lawyer or Member will issue a written outcome which contains the agreement.

When no agreement is reached

If agreement is not reached at the teleconference, the senior lawyer or member will issue either:

  • an interim payment direction, if the dispute is about weekly payments or medical expenses, or
  • a recommendation, if the dispute is about workplace injury management.

All parties will receive a copy of the interim payment direction or recommendation.

In disputes concerning workplace injury management, the senior lawyer or member may first direct that an independent injury management consultant (IMC) or other suitably qualified person conduct a workplace assessment in connection with the dispute. This may involve the IMC discussing the workplace needs with the worker, employer and the worker’s treating doctor. The IMC will provide the Commission with a workplace assessment report, which will be issued to the parties. The senior lawyer or Member may hold a further teleconference to discuss the report and attempt to find a resolution with the parties before issuing a recommendation.

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Review of decisions

A party may seek review of a decision of the senior lawyer or Member.

Interim payment direction

Either party can apply to the President to revoke an interim payment direction. In some matters involving weekly compensation, there may be a limited right of appeal to a Presidential Member

Recommendation

A recommendation in relation to a work injury management dispute is also reviewable if a party makes a written request to the President within 14 days of the recommendation being issued.

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