Issue 1 – Managing Review Time Frames.

Welcome to the initial 20:20 Report designed to highlight issues affecting Workers’ Compensation Industry with a view to providing information and assistance that be useful in understanding or managing the issue. It is important that members or individuals seek their own independent advice on any of the issues that are raised or discussed in the ’20:20 Report’.

It has come to the attention of members that due to high volumes of review applications and reducing staff levels within the Review Unit, that delays are occurring in allocating applications to review officers of between 30 to 40 business days. As you may be, aware Review Officers have 25 business days to make a decision and a further 10 business days to provide written reasons for the decision. It is therefore possible for the legislated review period to be exceeded even before the case is allocated to a review officer.

It is important that injured workers are informed in advanced of the potential delays in the review process so that they can make timely and informed decisions in regards to lodging early reviews with the Review Unit. Workers have 3 months to lodge a review, however if they delay in lodging the review application the additional time taken to allocate an application may delay other opportunities to resolve issues whilst they await a decision.

The intention of the legislation is to provide a prompt and non-adversarial process for review of insurer decisions. Unfortunately, the delays in allocating applications to review officers appear to be increasing. It also appears that in the absence of a prioritising process to advance particular cases for early review, some workers could face financial difficulties or psychological issues whilst waiting for a review decision.

Here are some options to consider when advising workers of a reviewable decision made by the insurer:-

  1. When providing reasons for decision to workers, the insurer could highlight that there may be significant delays in the allocation process to a review officer and encourage workers who wish to have the decision reviewed to do so promptly;
  2. The insurer could advised the Worker or their agent that under Section 546 “ If the Regulator does not make a review decision within the time allowed under section 545(1) or (4), the applicant may appeal to an industrial magistrate against the Regulator’s failure to make the decision”;
  3. The insurer when providing details of the reasons for the decision to the worker could offer to self review the decision, if additional information was provided;
  4. The insurer could consider alternative dispute resolution options such as mediation to see if an alternative resolution strategy was appropriate;
  5. In cases where financial hardship may result, a worker could be advised to consider applying for other potential income sources. e.g. personal accident insurance, sickness benefits or maybe superannuation.
  6. Under Section 220 if the decision by the insurer has stopped compensation and the worker has not returned to work, the insurer must refer the worker to an accredited rehabilitation and return to work program.
  7. On receipt of a notification from the Review Unit of a delay in allocating an application, the insurer could write to the Director of Reviews and Appeals and act as an advocate for the worker by requesting consideration be given to expediting the allocation process having regarding to the particular circumstances of the case.
  8. In psychological cases, the worker could be referred to a relevant employee assistance program or the Workers’ Psychological Support Service coordinated by the QLD Council of Unions for assistance during the review period.

Insurers that experience regular reviews of claims decisions should endeavour to review their own decision-making processes to consider options in regards to improving their communication with workers about decisions and entitlements. This could include the development of simplistic and less legalistic reasons for decisions so the worker can better understand the reasons for the decision and clarify their entitlements.

If you would like any issues covered by the 20:20 REPORT please forward a brief email to outlining the topic you would like to be reviewed.