7.5.5 The Independent Review
The role of an Independent Review Officer
The worker’s application is allocated to an Independent Review Officer (IRO). The role of the IRO is to decide whether the decision is ‘sustainable’. A ‘sustainable’ decision has reasonable prospects of being maintained by a court.
The IRO cannot make a new decision or change the Agent’s decision. The IRO does not make a decision about whether or not a worker is entitled to a payment or service or if the Agent should have accepted a claim or liability for an injury, condition or disease. However, the IRO can direct the Agent to overturn the decision if it is not ‘sustainable’.
Conducting the Independent Review
The IRO will review the relevant information on the Agent’s file and any information from the worker. An IRO may request further information from the Agent or the worker (or their nominated person/representative) to help make their decision.
The IRO will consider issues such as:
- what information was available and considered by the Agent;
- the quality of any information considered by the Agent;
- any information the Agent may have overlooked;
- where any important information was missing;
- the use of certain kinds of information, such as surveillance;
- how the Agent analysed and applied the available information;
- what the notice of decision says and whether the reasons make sense;
- the workers’ compensation legislation, WorkSafe policies or guidelines;
- the effect of the ‘reviewable decision’ on the worker;
- what happened at conciliation;
- the relevance of any new information received after conciliation.
Review time
Unless advised otherwise, the review will be completed in the following time frames after receiving a valid application:
-
15 business days for a decision relating to provisional payments
-
42 days for a decision relating to medical and like services
-
56 days for decisions to reject a claim for compensation and decisions relating to weekly payment entitlements
The worker and/or their nominated representative and the Agent will be provided with the outcome of the application in writing.