When you are injured at work in the course of your work duties, you are generally entitled to claim workers compensation (eg weekly payments, medical treatment costs, rehabilitation). Most employers in Queensland are insured by Workcover Queensland, although some companies likes Coles and Woolworths have their own self-insurers.
When you apply for workers compensation benefits, Workcover has to make a decision as to whether to accept or reject your claim. Workcover will often reject a claim at first instance for an assortment of reasons (eg. Workcover does not consider the injury to be “work related” etc).
When Workcover rejects a claim, it will issue a “Reasons for Decision” stating the reasons why the claim has been rejected. Similarly, Workcover may have accepted your claim for a period of time, only to issue you with a “Reasons for Decision” that suddenly closes down your claim (eg. where a Workcover doctor has informed that your work-related injury has now ceased, or that the injury was primarily caused elsewhere etc).
Can I appeal WorkCover’s decision to reject my claim?
When you receive a “Reasons for Decision” from Workcover, you have only 3 months from the date of the Workcover’s decision to appeal it to the Workers Compensation Regulator. Because Workcover frequently rejects the legitimate claims of injured workers, appeals to the Regulator are often necessary. The Regulator is independent and can make a decision to confirm, vary or set aside Workcover’s original decision to reject or cease your claim.
If you fail to act appeal the Reasons for Decision within the 3 months, you will usually lose all entitlements to make a claim thereafter.
Steps to appeal WorkCover’s decision to the Regulator:
- Contact Attwood Marshall Lawyers for advice. We will immediately take your detailed instructions, obtain a copy of your WorkCover statutory benefits file from WorkCover, and acquire all relevant medical and other materials.
- Lodge a Review with the Regulator.
- Include in your Appeal, we will include written submissions, relevant medical evidence (reports, records, etc) and any other supporting material (statements/statutory declarations as to how the incident occurred, witness accounts, photographs, etc);
- The Regulator will then decide your Appeal within 25 business days (although extensions of the timeframe are often required).
If the Regulator allows your Appeal, you will usually be put back onto WorkCover benefits (eg weekly payments and medical treatment), back-paid for any missed benefits to date, and allowed to continue with your workers’ compensation claim.
If the Regulator denies your Appeal and confirms WorkCover’s original decision, you must decide whether to appeal the Regulator’s decision to the Queensland Industrial Relations Commission (QIRC).
Steps to appeal the Regulator’s decision to the QIRC
You must file an Appeal of the Regulator’s Decision with the QIRC within 20 business days of receiving the Regulator’s decision. If you lodge an appeal, the Office of Industrial Relations will defend your Appeal on behalf of the Regulator. Generally, if your QIRC appeal is successful, the other side will have to pay your costs (although usually not all of your costs). However, if your QIRC appeal is unsuccessful, you will usually become liable to pay the legal costs of the other side in defending your appeal in the QIRC. Simply put, the loser has to pay the winner’s costs.
- Lodge an Application to Appeal Against the Regulator’s Decision with the QIRC within 20 days of the Regulator’s decision;
- Once the appeal is lodged, send a copy of the Notice of Appeal to the Office of Industrial Relations within 20 business days.
- The parties will be required to submit a Statement of Facts and Contentions, arrange evidence and witnesses, disclose materials to the other side, and then attend a conference/mediation.
- You will then be required to attend the QIRC hearing.
- The QIRC Commissioner will hear the appeal and make a decision that accepts or rejects your Appeal.
- Costs will normally be awarded against the losing party.
If you disagree with the QIRC decision, you can appeal to the Industrial Court within 21 days of the QIRC decision. The decision of the Industrial Court is final.
Appeals to the QIRC are often required to obtain a just and equitable outcome and to provide you with access to the workers’ compensation benefits to which you are entitled. Strict time limits apply.