Dispute Resolution Reforms

Dispute Resolution Reforms

by | Jan 14, 2019 | Claim management, Injured Worker, Injury Management, Reforms, Workers Compensation

Beginning 1 January 2019, the State Insurance Regulatory Authority (SIRA) introduced reforms to the workers’ compensation dispute resolution process, aligning with the Workers Compensation Legislation Amendment Act 2018. These reforms were designed to streamline claims handling, reduce disputes, and improve support services for injured workers and employers.

Goals of the Reform

  • Minimize disputes through clearer processes
  • Improve efficiency in claims management
  • Ensure faster responses from insurers
  • Enhance transparency and accountability
  • Provide stronger support services for both workers and employers

Five Key Changes Impacting Injury Management

  1. Centralized Dispute Resolution
    • The Workers Compensation Commission (WCC) now resolves all disputes.
    • Injured workers benefit from mandatory internal reviews, ensuring fairer outcomes.
  2. Timely Insurer Responses
    • Insurers must respond within 14 days to work capacity decisions or liability reviews.
    • Legal costs for workers challenging work capacity decisions are covered by Independent Legal Assistance & Review Service (ILARS).
  3. Improved Decision Transparency
    • Notice templates must clearly identify information received from employers, workers, and insurers.
    • This ensures decisions are based on complete and balanced evidence.
  4. Clear Complaint Pathways
    • Workers’ insurer remains the first point of contact.
    • Unresolved employer complaints go to SIRA (13 10 50 / contact@sira.nsw.gov.au).
    • Unresolved worker complaints go to Workers Compensation Independent Review Office (WIRO) (13 94 76 / contact@wiro.nsw.gov.au).
  5. Permanent Impairment Compensation
  • In certain cases, the WCC can award permanent impairment compensation without referral to an Approved Medical Specialist.

Please contact us to discuss.

New Claim Model – March Update

New Claim Model – March Update

by | Mar 15, 2018 | Claim costs, Claim management, Uncategorized, Workers Compensation

ABILITY GROUP is proud to announce the March update to our New Claim Model, a significant enhancement designed to streamline processes, improve transparency, and deliver greater value to our clients. This update reflects our ongoing commitment to innovation and efficiency, ensuring that businesses can manage claims with confidence while maintaining compliance with industry standards.

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New Claim Model – March Update

New NSW Claims Model Update

by | Feb 16, 2018 | Claim costs, Claim management, Claims, Reforms, Workers Compensation

The New South Wales (NSW) Claims Model has recently undergone significant changes, reshaping the way claims are managed and processed. At ABILITY GROUP, we understand that these updates can feel complex for both clients and injured workers. Our goal is to provide clarity, guidance, and support during this transition, ensuring businesses remain compliant while workers receive the assistance they need.

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Increasing Workers Claim Fraud

Increasing Workers Claim Fraud

by | Jul 6, 2017 | Claim costs, Claim management, Injured Worker, Investigations, Workers Compensation

According to a recent article there has been a significant increase in complaints in relation to workers compensation claims fraud. Fraudulent claims include claiming for a non-work related injuries, failure to declare information, altering medical certificates, etc. The recent conviction of a fraudulent worker highlights the emphasis placed on legitimate claims.

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