Work Capacity Decisions: Appealing a Decision

First review step: Internal Review

The first option for a review is called an Internal Review. An internal review is conducted by the insurer. It must be conducted by someone other than the initial decision maker. In practice most (if not all) insurers have a separate team for internal reviews.

The internal review will consider the merit of the original decision.

An application for internal review must be made in the approved form. Currently there is no time limit for making an application for internal review however, if the application for an internal review is not made within 30 days of receiving the decision, an injured worker cannot take advantage of the stay provisions.

The stay provisions are complicated but at their basic level: if the application is made within 30 days the original decision cannot take effect until the internal review decision has been completed.

The stay provisions do not extend the notice period.

Injured workers will still need to provide work capacity certificates while requesting a review of a work capacity decision

Help in writing an internal appeal is available in chapter 5 of the IWSN  Workers Compensation handbook

IWSN Work Capacity Decision Series. no 4 -with thanks to Sherri Haywood & the CFMEU