In Queensland, if you disagree with a decision made by WorkCover regarding your claim, you have the right to challenge it. This includes decisions to reject your claim, terminate or decrease your payments, or any other unfavourable decision. The appeal process is designed to ensure all decisions are fair and unbiased. Below is a guide that outlines the steps to take when appealing a WorkCover decision.
Appealing a WorkCover Decision
Step 1: Request a Review
The first step in appealing a WorkCover decision is to request a review by the Workers' Compensation Regulator. This must be done within three months of the decision date. The Workers' Compensation Regulator is an independent body reviewing decisions made by WorkCover Queensland.
How to Request a Review:
- Gather Information: Collect all relevant details of your claim, including the claim number, employer details, facts relating to the claim, and the decision documents from WorkCover.
- Submit Your Application: You can lodge your application for review online, by mail, or in person. Make sure to explain why you believe the decision is wrong and provide supporting documents such as medical reports, witness statements, and photos.
- Wait for the Decision: The Workers' Compensation Regulator then has 25 business days to review your application and make a decision.
Step 2: Appeal to the Queensland Industrial Relations Commission (QIRC)
If the review by the Workers' Compensation Regulator does not result in a favourable outcome, you can further appeal to the Queensland Industrial Relations Commission (QIRC). This must be done within 20 business days of receiving the review decision.
How to Appeal to the QIRC:
- Prepare a Notice of Appeal: Use Form 9 WCR Notice of Appeal, available on the QIRC website. Attach the review decision document to your notice of appeal.
- File the Appeal: Submit the Notice of Appeal to the QIRC. This can be done in person, by fax, mail or email.
- Notify the Workers' Compensation Regulator: Send a copy of the Notice of Appeal to the Workers' Compensation Regulatory Services within 10 business days of filing the appeal.
Step 3: Prepare for the Hearing
Once your appeal is lodged, the QIRC will issue directions for the management of the appeal, including the preparation of documents, statements of facts, and lists of witnesses.
Preparation Steps:
- Gather Evidence: Collect all relevant documents and evidence that support your case. This may include medical reports, witness statements, and any other pertinent information.
- Attend a Section 552A Conference: If you are representing yourself, you will be required to attend a conference with the respondent and a QIRC member to discuss the appeal process.
- Prepare for the Hearing: Arrange for your witnesses, including doctors, to give evidence at the hearing. Ensure all documents are exchanged with the other party at least ten business days before the hearing.
Step 4: Attend the Hearing
During the hearing, you will need to prove your case on the balance of probabilities (that what the accuser claims is more likely true than not). The Commissioner will hear both sides and make a decision based on the evidence presented.
Step 5: Pay Any Appeal Costs
If you engage a solicitor or other representative, you will need to cover the associated costs. If your appeal is unsuccessful, you may also be required to pay the respondent's legal costs.
Additional Information
- Employer's Role: Employers can also appeal WorkCover decisions and may be required to provide information during the appeal process. However, they cannot appear as a party to a worker's appeal.
- Legal Advice: It is advisable to seek legal advice to understand your rights and the appeal process better. Free services are available through the Workers' Compensation Advisory Service and the Chamber of Commerce and Industry Queensland.
Navigating the Appeal Process
Appealing a WorkCover decision can be a complex and daunting process, but knowing your rights and following the correct procedures can significantly increase your chances of a fair outcome. By requesting a case review, preparing thoroughly for any hearings, and seeking legal advice when necessary, you can ensure that your case is presented effectively.
If you have any questions or need assistance with your appeal, consider seeking legal advice from experienced professionals. At Smith's Lawyers, we’re experts in workers' compensation claims and can provide the guidance you need to navigate the appeal process. For a confidential consultation, call us at 1800 960 482 or request a free case review.
