Comcare: Appealing a decision.

The Internal Appeals Process

Comcare calls this a “Request for Reconsideration”.

A reconsideration is conducted ‘on the papers’. It is not a court process. This means that Comcare will not investigate but will review all relevant documents on the claim file and any additional information provided during the reconsideration process.

You have 30 days after you receive the original determination to lodge a request for reconsideration with Comcare (by the reconsiderations team). If you do not have this in within 30 days Comcare will not review your request but you can still take it to the Administrative Appeals Tribunal.

Comcare wont review what they call  “administrative decisions” such as the date of injury and the label of an accepted condition. A letter advising of an intention to make a decision is also not reviewable​

Some determinations that can be reviewed include:

  • decisions to accept or deny a claim for compensation
  • decisions to stop payment of compensation
  • decisions to increase or decrease weekly payment of compensation
  • decisions in relation to your rehabilitation.
  • decision not to pay for certain medical treatment

You are able to present new evidence. Comcare suggests that this should be done when you put in your appeal but there is nothing stopping you from doing this after you have put in your appeal. It is advisable to get it in as quickly as possible though.

When Comcare receives your reconsideration request it will:

  • allocate the reconsideration to an independent Review Officer
  • acknowledge the request for reconsideration to all parties;
  • provide an opportunity for the responding party to comment on new evidence and information.
  • assess any new evidence you provide, along with all relevant evidence on the claim file, in line with the SRC Act
  • in limited circumstances, request any necessary additional information
  • issue you with a decision in writing, which is known as a “reviewable decision.”

Where new evidence has been presented, the other affected party will be provided a period of time to respond to the request for reconsideration and the process will commence.

If you wish to draw the Review Officer’s attention to particular documents on the claim file, you should do so in your request for reconsideration. Alternately your Review Officer can also answer any questions you have about the reconsideration process over the phone.

Comcare aims to have a review completed within a maximum of 60 days from the date that Comcare receives the reconsideration request. The Reconsiderations Team aim to have a decision made earlier but your Review Officer will be the best person to provide advice on the expected time frame

Comcare provides the reviewable decision in writing. A reviewable decision can do the following in relation to a claim determination under review:

  • affirm – the determination under review does not change
  • vary – the determination under review is changed in some way
  • revoke – the determination under review is overturned and replaced with the reviewable decision

You can access legal assistance to complete a request for review but you will have to pay for it yourself.

Appealing to the Administrative Appeals Tribunal

If you are not satisfied with a decision made by Comcare’s Reviews Team, you may appeal to the Administrative Appeals Tribunal (the AAT) for a further independent review of the decision. You will need to prepare an Application for Review form which you can find on the AAT’s website.

You have 60 days from the original decision to appeal to the Administrative Appeals Tribunal.​

You have the right to skip the Comcare review and go straight to the Administrative Appeals Tribunal.

There are no fees to lodge a claim. ​

The decision made by Comcare remains in force unless and until the Administrative Appeals Tribunal overturns that decision. If you want to ask the AAT to suspend the operation of the decision, you must fill out a Request for Stay Order form.

To appeal a Comcare decision you need to fill out a form:

the online form can be found here: Online form

A paper form can be found here: Paper form

At the AAT, Comcare is represented by a lawyer either internal or from an external law firm.

The Injured Workers Support Network strongly recommends you engage a lawyer to assist with your appeal though this is not compulsory.

The Administrative Appeals Tribunal provides a useful guide to the appeals process click on this to read more.
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IWSN Comcare Series. no 5