Dispute Resolution Reforms

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

Injury Management

Beginning 1 January 2019, the State Insurance Regulatory Authority (SIRA) are applying new reforms to the workers compensation dispute resolution process to align with the Workers Compensation legislation Amendment Act 2018.

The goal of these changes is to minimise dispute by streamlining the system, making it easier and more effective for claims processing and support services.

5 key changes which bring positive effects to the injury management process:

1. The Workers Compensation Commission (WCC) will now resolve all disputes, as they now have mandatory internal reviews for injured workers.
2. The option to apply for an internal review of the insurer’s decision is still available.
   • For a work capacity decision or review of liability, the insurer is required to respond within 14 days. Worker legal costs for reviews of work capacity decisions will be met by Independent Legal Assistance & Review Service (ILARS).
3. Notice of insurer decision
   • Existing notice templates will need to identify information received from the employer and considered in addition to information received from workers and insurer.
4. The insurer is the first point of contact workers compensation complaints and enquiries in the first instance. Injured workers, employers and service providers also have the option to also call the iCare Complaints & Enquiries team on 13 99 22.
   • Unresolved complaints and enquires for employers will be directed to SIRA on 13 10 50 or contact@sira.nsw.gov.au.
   • Unresolved complaints and enquires for workers will be directed to Workers Compensation Independent Review Office (WIRO) on 13 94 76 or contact@wiro.nsw.gov.au.
   • If a worker has a complaint about their employer or provider, they are advised to contact SIRA.
5. Permanent impairment compensation without referral to an Approved Medical Specialist may be awarded by the WCC in certain circumstances.

Other smaller changes include:

• The mandatory electronic delivery of workers compensation information to employees
• Changes to the definition of PIAWE to include shift and overtime allowances, and ability to settle on PIAWE rate in certain circumstances.
• Injured workers who receive workers compensation benefits as well as CTP damages for the same injury will only need to repay to the workers compensation insurer the amount of weekly payments received.
• Injured workers who were identified to be in the ‘catastrophic injury’ category will continue to receive medical benefits under the workers compensation scheme, even if they commute their weekly benefit entitlements.

If you would liek to discuss or need help, please contact us to discuss.