Request an independent review of an Agent decision (PDF version)

Download the form to request a review.

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What it contains

The Workers Compensation Independent Review Service

We understand that sometimes decisions might not seem right. To assist you in these situations, WorkSafe Victoria has established an independent service for workers that can review certain Agent decisions made under the Workplace Injury Rehabilitation and Compensation Act 2013 or the Accident Compensation Act 1985 (compensation legislation).

The Workers Compensation Independent Review Service (WCIRS) is a free service and is available when you want us to review a decision that an Agent has made that doesn’t seem right to you.

We can review most Agent's decisions within 6 months of when you became aware of the decision once the conciliation process at the Workplace Injury Commission has finished and within 30 days after the conciliation officer issues a Genuine Dispute Outcome Certificate

Before you start

Please read the included fact sheet before filling out and lodging this form. It provides further information about which decisions are reviewable, when and how you can seek a review and the requirements for submitting an independent review application. You can also visit worksafe.vic.gov.au/WCIRS for more information.

Filling in and lodging this form

We will only ask you for information that we need for the review. Although we have access to your compensation claim information, this form will ask you for some of that information to verify your identity and to help us understand which decision you would like reviewed.

Once you have filled in this form, you can send it in to us:

  • By email to:  
    [email protected]
  • By post to:  
    Workers Compensation Independent Review Service 
    WorkSafe Victoria 
    PO Box 279 
    Geelong VIC 3220

If you prefer, you can also lodge this form using our online portal by visiting worksafe.vic.gov.au/WCIRS

If you need help completing this form, please call us on (03) 4243 7061. Our friendly staff can assist you to fill in the form and send it to you by e-mail or post to review, sign and return to us. If you require a translator, please let them know when they answer and they will be happy to assist.