The Workers Compensation Independent Review Service

The Workers Compensation Independent Review Service

What is the Workers Compensation Independent Review Service (WCIRS)?

After receiving hundreds of complaints from workers regarding WorkSafe’s processes and conduct in 2018, the Victorian Ombudsman investigated and released a report in December 2019. One of the recommendations from the report was that WorkSafe create an independent unit to review decisions made by agents.

On 30 April 2020, the WCIRS was established to independently review ‘reviewable decisions’ which the worker believed was incorrect or unfair or referred to conciliation but remained unresolved. The review must be requested by the worker and is a free service.

The review time frames vary depending on the complexity of the dispute decision but reviews can be completed between 15-56 business days. When the Independent Review Officer finds that a decision is unsustainable or has reasonable prospects of success at Court, WorkSafe can use their power to direct agents to overturn those decisions.

What is a ‘reviewable decision’?

Any decisions made on or after 3 December 2019 by an agent relating to the acceptance or rejection of:

  • your WorkCover claim
  • your entitlement to medical and like services/expenses
  • your entitlement to weekly payments
  • whether or not you have a current work capacity.

Are there any limitations when accessing the WCIRS?

An independent review can be requested if:

  • the reviewable decision was made on or after 3 December 2019 and has gone through the conciliation process at the Accident Compensation Conciliation Service (ACCS); and
  • within 2 years of the date of the Genuine Dispute Outcome Certificate issued by the ACCS;
  • before the Victorian Magistrates’ or County Court has listed the matter for a final hearing to review the decision; or
  • before a medical question relating to the dispute is referred to the Medical Panel.

Case study

Prior to lodging a WorkCover claim for our client’s back injury, sustained while doing heavy and repetitive work, our client was employed on a full-time basis as a product assembler. Due to the severity, the claim was accepted for the exacerbation of a pre-existing degenerative condition in his lower back. His ongoing injuries and restrictions meant he was unable to return to work and was certified by his GP as having no capacity for work.

Despite this, the agent made a decision to stop paying weekly payments after 130 weeks to our client on the basis that he either:

  • had a current work capacity for suitable work; or
  • if he had no current work capacity, was unlikely to continue indefinitely.

Our client disputed the agent’s decision, proceeded to conciliations but was unable to resolve the dispute. He then sought an independent review.

The Independent Review Officer (IRO) found that the agent’s decision to cease paying our client’s weekly payments was not sustainable. The IRO felt that a Court may take a similar view when assessing the opinion of our client’s treating practitioners who had a long-standing and direct experience in the examination and treatment of him. The IRO found that realistically, our client would have difficulty attaining suitable employment in the labour market.

What happened next?

In reviewing our client’s case, the IRO directed that the agent must:

  1. overturn their decision within 2 days of the WCIRS decision;
  2. take steps to restore our client’s weekly payments; and
  3. write to our client confirming that the above has occurred.

As a result, the agent had to make back payments to our client for the period he did not receive weekly payments. The agent is also obligated to continue paying weekly payments to our client until he either reaches retirement age or until he resumes a capacity for suitable work.

Is going to Court better than going through the WCIRS?

The WCIRS outcome in our case study demonstrates how the independent review service can help workers access their entitlements after an incorrect or unfair decision.

The table below shows that over 41 per cent of finalised reviews resulted in the original decisions being overturned. This is a promising result given that the WCIRS is a free and relatively quick service when compared to the added delays, legal costs and stress of going to Court.

However, it is still recommended you seek advice from your lawyer to help determine which option best suits your dispute and circumstances.

WCIRS performance to date

Total number of decisions reviewed659
Affirmed300
Overturned (by direction of WorkSafe)209
Withdrawn (by agent)53
Withdrawn (by worker)25
Pending72

If you believe you have received an unfair decision and need legal advice, contact our WorkCover lawyers on (03) 9321 9988.

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