7.5.6 Independent Review Outcomes
The possible outcomes of a WCIRS independent review are:
- The independent review can be discontinued before a final determination of the IRO because:
- the worker withdraws their WCIRS application or
- the Agent withdraws the reviewable decision or
- The WCIRS concludes the independent review and finds that the reviewable decision:
- is not a ‘sustainable decision’ and directs the Agent to overturn the decision in accordance with the compensation legislation or
- is a ‘sustainable decision’ and confirms the decision
Note: WCIRS is an independent integrity function and the review findings document contains the Independent Review Officer’s reasons for their opinion as at the time of the review. WCIRS determinations are not legal precedents or a representation of WorkSafe’s position about a particular issue or policy.
Worker withdraws WCIRS application
A worker can withdraw an application for an independent review at any time before a final outcome is communicated by the WCIRS.
The Agent will be notified in writing by the WCIRS when a worker withdraws their application for an independent review.
Agent withdraws ‘reviewable decision’
An Agent can reconsider a reviewable decision at any stage during the independent review and before a decision is issued by the WCIRS IRO.
The Agent can withdraw a reviewable decision before the conclusion of a WCIRS Independent Review. The effect of the Agent withdrawing the reviewable decision will be different for each application and, generally will depend on whether the worker was already receiving a payment or service at the time the Agent’s decision was made (see below).
WCIRS will cease the independent review if the Agent withdraws the decision.
Reviewable decision is found not to be a sustainable decision and is overturned
The effect of a direction by the WCIRS to an Agent to overturn a reviewable decision (or where it is withdrawn by an Agent) depends on whether the worker was already receiving a payment or service at the time the reviewable decision was made by the Agent.
Already receiving a payment or service at the time of the Agent’s decision
If the worker was already receiving a weekly payment related to the decision or a medical or like service when the Agent decision was made, within 2 business days of the decision being overturned or withdrawn, generally, the Agent will:
- restore the payment or service, including payments or services that the Agent would have been required to pay if it had not made the decision, in accordance with the compensation legislation and
- write to the worker confirming this has occurred.
Where the worker was not receiving a payment or service at the time of the Agent’s decision
If the worker was not receiving a weekly payment related to the decision or a medical or like service when the Agent decision was made, within 2 business days of the decision being overturned, generally, the Agent will:
- commence re-assessing and re-making the decision in accordance with the findings, reasons or recommendations given or made by the IRO and the workers’ compensation legislation and
- write to the worker confirming that this has occurred
Reviewable decision is found to be a sustainable decision.
If the WCIRS determines that a reviewable decision is sustainable, the decision remains unchanged and the worker can still apply to resolve the dispute at Court or arbitration.
7.5.7 Court or Arbitration Proceedings
A WCIRS independent review is an optional step in the workers’ compensation dispute resolution process. A worker can apply to WCIRS before, during or after lodging an application at Court or for arbitration at the WIC Workplace Injury Commission, and before a Court or Arbitration Officer listing a final hearing date for review of the decision or referring a medical question relating to the decision to the Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12 for assessment.
An Agent may need to respond to Court or arbitration proceedings issued by the worker at the same time as the decision is being reviewed by the WCIRS.