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

Download the form to request a review.

Published: 16 Jan 2023
File type: PDF
File size: 139.7 kB
Length: 5 pages
Reading level: Medium

Application for an independent review of an Agent decision

We understand that sometimes decisions that are made 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 service is called the Workers Compensation Independent Review Service (WCIRS), which 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 Agents decisions made on or after 3 December 2019 once the conciliation process at the Accident Compensation Conciliation Service has finished and the conciliation officer issues a Genuine Dispute Outcome Certificate or a Court finds that there is a Genuine Dispute when revoking a direction given by the conciliation officer to an Agent in relation to the decision.

Before you start

We encourage you to read 'what workers need to know about an independent review' before filling out and lodging this form. That page provides you with further information about which decisions are reviewable, when and how you can seek a review and the process and the requirements for submitting an independent review application.

Filling in and lodging this form

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

If you need help completing this form, please call our service directly on 03 4243 7061 or email [email protected]. Our friendly administration staff can guide you through the application process. If you require a translator when you call, please let them know when they answer and they will be happy to assist.