The role of an Independent Review Officer
The worker’s application is allocated to an Independent Review Officer (IRO). The role of the IRO during the review is to determine whether or not the decision being reviewed is ‘sustainable’. Generally speaking, a ‘sustainable’ decision is a quality decision made by the Agent that is fair, reasonable, based on the best available evidence which has been properly considered and applied and has been clearly communicated and explained.
The IRO is not able to make a new decision or change or alter the Agent’s decision. This means that 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 found to not be ‘sustainable’ – see further detail below.
Conducting the Independent Review
An IRO will review the relevant information on the Agent’s claim file and any supporting information that a worker provides with their application. Where it is necessary, an IRO may request further information or clarification from the Agent or the worker (or their nominated person/representative) to help them make their decision.
The IRO will independently review how the Agent made the ‘reviewable decision’ by looking at things like:
- 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 that apply to the ‘reviewable decision’;
- the effect of the ‘reviewable decision’ on the worker;
- what happened at conciliation;
- the impact and use by the Agent of any new information on the ‘reviewable decision’.
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 person or representative and the Agent who made the decision will be provided with the outcome of the application in writing.