An Agent's role during a Workers Compensation Independent Review of a decision

Information and guidance for agents when an injured worker asks the Workers Compensation Independent Review Service (WCIRS) to review an agent’s decision.

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What we do

For information about which agent decisions made under the Workplace Injury Rehabilitation and Compensation Act 2013 or the Accident Compensation Act 1985 (compensation law) we consider are 'reviewable decisions' and when and how we review them, please visit the page titled 'What you need to know about a workers compensation independent review.'

Interactions between WCIRS and agents during an independent review

As the WCIRS is conducting an independent review of an agent's decision, interactions between our service and the agent will be limited to notification of an independent review, requests for further information (where required) and communications relating to the outcome of an independent review. WCIRS will have access to all claims information via the Novus claims platform.

Notification of an independent review

WCIRS will notify an agent in writing when an Independent Review is being conducted via a task in Novus and an e-mail to the agent's centralised inbox.

Request for further information

WCIRS may ask an agent to provide further information to assist with the independent review. Due to the quick timeframes that apply to a review, an agent must provide any information requested within 3 business days of receiving a request. Depending on the nature of the information request, the information can be provided by email or on Novus.

Communication with employers

As with other communications relating to agent decision-making, it continues to be the agent's responsibility to keep employers informed about the existence, progress and outcome of a workers compensation independent review.

Independent review outcomes

The following are possible outcomes following an independent review:

  1. 1. The independent review is discontinued before a final determination of the WCIRS because the:
    1. worker withdraws the WCIRS application
    2. agent withdraws the reviewable decision, or
    3. arbitration or court lists a final hearing relating to the decision
  2. The WCIRS concludes the independent review and finds that the reviewable decision:
    1. is not a ‘sustainable decision' and directs the agent to overturn the decision in accordance with the compensation law, or
    2. is a sustainable decision and confirms the decision

Worker withdraws their WCIRS application

A worker can withdraw an application for an independent review at any time before the final outcome of the independent review being communicated by our service.

We will notify the agent in writing when a worker withdraws their application for an independent review.

Agent withdrawal of a 'reviewable decision'

The agent can reconsider a reviewable decision at any time during the review period.

The agent is able to withdraw a reviewable decision before an Independent Review Officer (IRO) issuing the final outcome of the independent review.

The effect of the agent withdrawing the reviewable decision will be different for each application and will depend on whether the worker was already receiving a payment or service at the time the agent’s decision was made.

Worker already receiving a payment or service at the time of the Agent's decision

If the worker was already receiving a weekly payment related to the decision or a medical or like service when the agent decision was made, within 2 business days of the decision being withdrawn, generally, the agent must:

  1. restore the payment or service, including payments or services that the agent would have been required to pay if it had not made the withdrawn decision, in accordance with the compensation law, and
  2. write to the worker confirming this has occurred

An agent may choose to make a new decision after it is withdrawn and must write to the worker communicating what the new decision is.

Worker not receiving a payment or service at the time of the Agent's decision

If the worker was not receiving a weekly payment related to the decision or a medical or like service when the agent decision was made, within 2 business days of the decision being withdrawn, the agent must:

  1. commence re-making the decision, and
  2. write to the worker confirming that this has occurred

Upon notification of a withdrawal by the agent of a reviewable decision, the WCIRS will discontinue the independent review. We will also provide confirmation in writing to both the agent and the worker that the independent review has been discontinued as a consequence of the agent's decision to withdraw the reviewable decision.

Overturned reviewable decisions

The effect of a direction by an IRO to an agent to overturn a reviewable decision will be different depending on whether the worker was already receiving a payment or service at the time the reviewable decision was made by the agent.

Worker already receiving a payment or service at the time of the Agent's decision

If the worker was already receiving a weekly payment related to the decision or a medical or like service when the agent decision was made, within 2 business days of the decision being overturned, generally, the agent will:

  1. restore the payment or service, including payments or services that the agent would have been required to pay if it had not made the withdrawn decision, in accordance with the compensation law, and
  2. write to the worker confirming this has occurred

An agent may choose to make a new decision if is overturned and must write to the worker communicating what the new decision is.

Worker not already receiving a payment or service at the time of the Agent's decision

If the worker was not receiving a weekly payment related to the decision or a medical or like service when the agent decision was made, within 2 business days of the decision being overturned, generally, the agent will:

  1. commence re-assessing and re-making the decision in accordance with the findings, reasons or recommendations given or made by the IRO and the compensation law, and
  2. write to the worker confirming that this has occurred

Decision is confirmed

If the WCIRS finds that the reviewable decision is 'sustainable' the decision will be confirmed and remain unchanged.

The worker and the agent will be notified of the WCIRS findings in writing.

Arbitration or court proceedings

The independent review process is an optional step in the workers compensation dispute resolution process. It can be started by the worker before, during or after lodging a referral for arbitration or an application at court, so long as the application is made within 6 months of becoming aware of the Agent decision and 30 days of the Genuine Dispute Outcome Certificate (GDOC) being issued by the Workplace Injury Commission and before arbitration or court listing a final hearing date for review of the decision or referring a medical question relating to the decision to the Medical Panel for assessment.

If the 'reviewable decision' is listed for a final arbitration or court hearing date or referred to the Medical Panel during an independent review, we will cease the review and take no further action.

It is therefore possible an agent may need to respond to arbitration or court proceedings issued by the worker while the decision is being reviewed by the WCIRS.

Further information

Agents can contact our service on 03 4243 7061 for further information about the independent review process between 8:30am and 4:30pm, Monday to Friday.

Related information

WorkSafe Advisory Service

WorkSafe's advisory service is available between 7:30am and 6:30pm Monday to Friday. If you need more support, you can also contact WorkSafe using the Translating and Interpreting Service (TIS National) or the National Relay Service.

1800 136 089 More contact options