7 Dispute Resolution
7.1 Types of disputes | 7.2 Senior review | 7.3 Conciliation | 7.4 Conciliation conference | 7.5 Workers' Compensation Independent Review Service | 7.6 Medical panel | 7.7 Magistrates' Court & County Court | 7.8 Cost of disputes | 7.9 Arbitration Service
WorkSafe aims to minimise disputes by consistently applying claims assessment and management procedures. However, if a dispute arises, it is in everyone’s interest to resolve it quickly and fairly to avoid litigation.
Disputes can arise when there is disagreement between the worker and the Agent about:
- weekly payments
- medical & like services
- provisional payments for a mental injury
- the liability for impairment benefits
- superannuation contributions
- interest on an outstanding amount
- lump sum payments & pensions to dependants and other entitlements following the death of a worker
- access to information & privacy
- common law
Weekly payments
Disputes about weekly payments referred for conciliation can be about:
- liability to make or to continue to make payments
- whether a worker has or does not have a current work capacity Under the legislation, unless inconsistent with the context or subject-matter — current work capacity, in relation to a worker, means a present inability arising from an injury such that the worker is not able to return to his or her pre-injury employment but is able to return to work in suitable employment, declared training program
- any other matter which effects the payment or calculation of weekly payments.
Medical & like services
Disputes about medical and like services can be about:
- the general liability of the employer/WorkSafe to pay compensation for medical and like services
- WorkSafe’s liability for the reasonable costs of a particular service or type of service.
If the dispute raises a unique or scheme sensitive issue as to the reasonable cost of a particular service, consider involving legally qualified Agent staff or WorkSafe.
Provisional payments for a mental injury
Disputes about provisional payments for a mental injury can be about:
- WorkSafe’s general liability to pay provisional payments in respect of a claim
- WorkSafe’s liability to pay for the reasonable costs of a particular service or the type of service requested under provisional payments.
Impairment benefits
If a worker disputes a decision to reject liability for injuries included in the claim, the worker must refer the dispute for conciliation.
Interest on an outstanding amount
Disputes about interest can be about:
-
WorkSafe’s general liability to pay interest on late payments
-
the amount of interest calculated.
Superannuation contributions
Disputes about superannuation contributions can be about:
-
WorkSafe’s general liability to make superannuation contributions
-
the start date of any payable superannuation contributions.
Maims & pain & suffering claims
If the worker disputes the decision to reject the claim, they must refer the dispute to the WIC Workcover Injury Commission.
A Conciliation Officer may request the worker to have a medical examination conducted by an approved medical practitioner or refer medical questions to a 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 an opinion.
If the Conciliation Officer determines that the worker has taken all reasonable steps to settle the dispute, the Conciliation Officer is required to issue a certificate to:
- certify that all reasonable steps have been taken by the worker to settle the dispute
- identify all medical reports provided by one party to another and any medical reports obtained by the Conciliation Officer
- specify the opinion of the Medical Panel (if relevant)
- be served on all parties to the dispute.
Access to information
The Conciliation Officer may recommend or direct an Agent to release some or all of the exempt information to the worker or they may be satisfied that a genuine dispute A genuine dispute is one in which the parties cannot reach an agreement but the conciliation officer considers the dispute is genuine. exists.
If the Conciliation Officer directs or recommends the Agent to release some or all of the exempt information to the worker, the Agent must release that information within seven days unless a formal application to have the direction revoked has been made.
If the Agent has an arguable case in support of the refusal to release exempt information, then the Conciliation Officer accepts there is a genuine dispute. The Conciliation Officer advises the worker that an application may be made to the court to determine the matter.
Death of a worker
If the dispute relates only to medical and like expenses (reasonable costs of burial or cremation or counselling or other medical expenses) the Conciliation Officer may recommend or direct the Agent to pay the reasonable costs of the expenses (to a maximum of $5,000 per claim) and must give a Certificate of Genuine Dispute if there is an arguable case.
The claimant A person who applies for WorkCover benefits. is not required to refer the following disputes to the WIC before commencing court proceedings:
- compensation for the death of a worker
- reimbursement of expenses incurred by non-dependent family members Family member means a partner, parent, grandparent, sibling or child of the worker or of the worker's partner of a deceased worker
- weekly pensions for dependents of a deceased worker.
However, the WIC can still conciliate the dispute. If this occurs, the WIC is limited to issuing an 'unresolved' certificate if the dispute is not settled.
If the death and dependency claim has been allocated to a legal panel firm for management, the Agent representative must liaise with that firm before conciliation and consider whether lawyers for each party should attend the conciliation.