How do I appeal WorkCover’s decision to the Regulator?

If you apply for worker’s compensation benefits after an injury, sometimes there is disagreement with WorkCover (or the insurer). You may have no choice but to appeal the decision which you disagree with.

Common disputes

Some disputes arise at the beginning when you make your workers compensation claim, while others may emerge later.

For example, when you file your compensation application, WorkCover may dispute whether you suffered an injury at work. They may allege that your injury is not new, but rather pre-existing. Often times there can be a pre-existing injury which is then aggravated in the work event. When this occurs, you are entitled to be compensated for the aggravation, which counts as the “new” injury.

Another example of a disputed issue is whether WorkCover should decrease your weekly payments or whether they should completely end your claim.

Yet another example is when Workcover says that your application for compensation is out of time.

Appeals to the Regulator

The first step in the appeals process is that you appeal to the Worker’s Compensation Regulator.

The Regulator is independent from WorkCover Queensland (and if your employer is a self-insured organisation, then from your employer).

The Regulator’s independence is particularly important if your employer is one of those few large Queensland based organisations which are licensed to self-insure. Increasingly, we see some of these large companies treating their workers poorly, and the Regulator’s independence is an important safeguard to ensure that these unfair decisions are reviewed and corrected.

Timeframes

The most important thing to remember is that there are strict timeframes to seek a review.

Once you are told that WorkCover (or the self-insured employer) has made a decision, you have 20 days to request the reasons for that decision. (Unless the reasons have already been provided).

You then have 3 months to appeal to the Regulator.

Appeal process

The appeal process conducted by the Regulator is not adversarial in nature. This means it is not like a court hearing. Rather, it is done “on the papers” by a review officer. This basically means that the review officer reads all relevant documents and then makes a decision about your case.

Having said that, there are some things you can do to be more involved in the review process.

Firstly, you can provide additional information to the Regulator which was not considered by WorkCover before. Natural justice requires the Regulator to provide that information to WorkCover, but this does not mean that they won’t accept it.

Secondly, in the review process you can request a “right of appearance”. This means that you request a personal interview with the review officer. This is an opportunity to meet face to face and to put forward some arguments to support your case.

Once the review officer has all necessary information, they will make a decision within 25 business days, although delays are a common occurrence.

Should you engage a lawyer?

Even though the review process conducted by the Regulator can be fairly straightforward, it is worthwhile to seek legal advice.

One reason for this is that a lawyer may help you identify the information which is most relevant and helpful to support your case. In our experience, when you are dealing with the stress of a WorkCover claim there are so many different events and people that you may have to deal with that it can be difficult to articulate the best grounds of your disagreement with the Worker’s Compensation insurer.

Secondly, it’s important to keep in mind that if the review by the Regulator is unsuccessful then any further appeal avenue (to the Industrial Commission or to the Industrial Court) may have significant cost consequences. That is because if you lose in the Commission or in the court, you will have to pay WorkCover’s costs. That could be significant. This is a risk which you do not have to worry about if your review application before the Regulator is successful. Hence, it is important to get it right.

25% Cap on legal costs

In all of our personal injury compensation matters, we act on a No Win – No Fee basis. What that means is, there’s no upfront cost to you.

In Queensland, most compensation firms will charge you 50% of your compensation amount – the maximum allowed at law. This is very expensive. Our fee is different. We will cap our fee at 25% . Remember also, these are the maximum fees we will charge. If our fee in your claim is less, then we charge the lesser amount.

Before you engage us, we will provide you a written Disclosure Notice and a Client Service Agreement. These documents set out in detail the service we provide, as well as our fees and outlays. Before you sign anything, you can take these documents home with you, and study them with your family. You can take as long as you need, there is never any pressure from us. If anything in these documents doesn’t make sense to you, we can discuss it with you and you are free to ask another lawyer to give you advice. And remember, no win – no fee agreements come with a 5 day cooling off period for extra peace of mind.