If an insurer/scheme agent decides to deny liability for all or part of your claim they must send you a letter that advises of their decision. The letter is required to set out, amongst other things:
- the decision (e.g. decline liability or reduce benefits)
- identify all matters in the decision
- state the reasons for the decision and issues relevant to the decision
- attach all documents relevant to the decision
- the procedure for requesting a review of the decision, with a standard review form attached.
If you want the insurer to review the decision you will need to complete that form and send it back to the insurer.
The insurer is required to respond back to you in writing within 14 days of receiving the request for a review. The insurer will either decide to accept the claim or maintain their decision and issue a reviewed notice, with any additional information relevant to this decision.
Make sure that in completing the form you raise with the insurer all of the relevant issues you would like them to reconsider including any additional information that you think the insurer should consider.
If you lodge an Application for Dispute Resolution at the Workers Compensation Commission you will only be permitted to include information that has been considered by the insurer and listed in the insurers notice.
If the insurer has sent you a review notice after requesting the optional review, and you are still wishing to dispute that decision you should use the review notice and the original notice to lodge your application with the Workers Compensation Commission.
Download a copy of the standard review form or contact the Claims Assistance Service on 13 10 50 for further assistance.