WorkCover rejected your claim, or stopped your payments. The review path, and its deadlines.

WorkCover Queensland rejects claims for a handful of recurring reasons: it decides you were not a "worker", that the injury did not arise out of your work, that work was not a significant contributing factor, that a psychological injury arose from reasonable management action, or that the application was late. It also makes decisions during a claim that can hurt as much as a rejection: that your injury has stabilised, that you have capacity for work, that treatment is no longer needed, or that weekly payments will stop. Every one of these is a reviewable decision.

Key points

• Any WorkCover decision can be reviewed by the Workers' Compensation Regulator within three months, free of charge.
• A review decision can be appealed to the Queensland Industrial Relations Commission within 20 business days.
• A rejection is not necessarily the end of the claim; a review turns on evidence that answers the stated reason for the decision.

Step one: the Regulator's review

You can apply to the Workers' Compensation Regulator for an independent review of an insurer's decision. The application must be lodged within three months of receiving the written decision, and the review is free. The Regulator looks at the decision afresh on the material before it, which means the review is only as good as the material you put in. Where a rejection rests on thin medical evidence, a treating specialist's report that addresses the actual reason for rejection is the kind of material a review turns on.

Ask the insurer for its full file and the reasons for the decision before lodging. A review application that answers each reason with evidence is a different thing from one that simply disagrees.

Step two: the Queensland Industrial Relations Commission

If the Regulator confirms the decision, you can appeal to the Queensland Industrial Relations Commission within 20 business days of receiving the Regulator's decision. An appeal is a fresh hearing: witnesses give evidence, doctors are called, and the Commission decides for itself whether the injury is compensable. Costs can be awarded, so advice before appealing is important. A decision confirmed by the Regulator is not necessarily the end of the claim, and the appeal is a further option available.

Step three: the Industrial Court

A further appeal, on questions of law only, lies to the Industrial Court of Queensland. Few cases reach it.

Decisions that are commonly challenged

• Psychological injury rejections relying on "reasonable management action". The exclusion only applies where the management action was reasonable and taken in a reasonable way, and where the injury arose from that action rather than from bullying, workload or a traumatic event. The evidence is in emails, complaints, rosters and witnesses.
• "Not a worker" decisions for contractors and labour-hire workers, where the real working arrangement, not the label, decides it.
• Cessation of benefits on the basis that the injury has stabilised or capacity has returned, where the treating doctors disagree with the insurer's medical examiner.
• Late applications, where a reasonable cause for the delay, such as a gradual injury or a delayed diagnosis, was not explained.

Medical disputes

Where the disagreement is medical, whether an injury has stabilised, or the degree of permanent impairment, the dispute may be referred to a Medical Assessment Tribunal rather than the Regulator. The Tribunal's decision on those medical questions is final, so the evidence put to it needs to be complete.

Time is the whole thing

Three months for the review. Twenty business days for the appeal. Neither can be extended lightly. If a decision letter arrives, the date on it is the day the clock starts, and getting advice in the first week gives time to gather what the review needs.

Frequently asked questions

How do I appeal a rejected WorkCover claim in Queensland? Apply to the Workers' Compensation Regulator for review within three months of the written decision. If the Regulator confirms it, appeal to the Queensland Industrial Relations Commission within 20 business days.

Does it cost anything to have a WorkCover decision reviewed? The Regulator's review is free. An appeal to the Commission can involve costs, so take advice first.

What is a Medical Assessment Tribunal? An independent panel of specialists that decides medical questions such as whether an injury is work-related or stable and the degree of impairment. Its decision on those questions is final.

Sources

• Workers' Compensation and Rehabilitation Act 2003 (Qld), s 32 (injury; reasonable management action), ss 540–545 (review by the Regulator; three-month time limit), ss 548–561 (appeals to the Industrial Relations Commission and Industrial Court; 20 business days), Chapter 11 (Medical Assessment Tribunals) — legislation.qld.gov.au
• Workers' Compensation Regulatory Services, Information statement for workers (review within three months; appeal within 20 business days) — worksafe.qld.gov.au
• WorkSafe Queensland, Independent review of insurer decisions and Appealing a review decision — worksafe.qld.gov.au
• Queensland Industrial Relations Commission, published decisions — qirc.qld.gov.au