If your workers’ compensation claim has been denied in New South Wales, you have the right to review the decision. The reviews process can be intricate, but understanding the steps involved can help increase your chances of a successful outcome. This article will provide a comprehensive guide on how to review a compensation decision in NSW, including gathering additional evidence, seeking legal representation, and what to expect during the reviews process.
Understanding the Reasons for Denial
The first step in reviewing a compensation decision is to thoroughly understand the reasons your claim was denied. The insurer is required to provide you with a Section 78 Notice, which outlines the specific reasons for their decision. This notice may cite issues such as:
- Insufficient evidence of a work-related injury or illness
- Disputes over the nature or extent of your injuries
- Disagreements about your capacity for work and entitlement to weekly benefits
- Denials of specific medical treatments or expenses
Carefully reviewing the Section 78 Notice will help you identify the key points of contention and guide your strategy for the reviews process.
Requesting an Internal Review
Once you have received the Section 78 Notice, you can request an internal review of the insurer’s decision. This is an important first step, as it allows the insurer to re-examine the evidence and potentially overturn or modify their original decision.
To request an internal review, you may need to complete a Review Form, which is typically included with the Section 78 Notice. In this form, you can outline the reasons why you believe the insurer’s decision should be different and provide any additional evidence or information to support your case.
The insurer must respond to your review request within 14 days. They may decide to overturn or modify their original decision, or they may maintain the denial of your claim.
Contacting the Independent Review Office (IRO)
If you are not satisfied with the outcome of the internal review, you can contact the Independent Review Office (IRO). The IRO is an independent statutory office that can assist with resolving workers’ compensation disputes.
When you contact the IRO, they may be able to help find a solution by contacting the insurer on your behalf. If the dispute cannot be resolved, the IRO may advise you to seek legal advice and potentially make an application to the Personal Injury Commission (PIC) of NSW.
Applying to the Personal Injury Commission (PIC)
If the internal review and IRO process have not resolved your dispute, the next step is to make an application to the Personal Injury Commission (PIC) of NSW. The PIC is an independent tribunal that hears and determines workers’ compensation disputes.
To make an application to the PIC, you will need to complete the appropriate form, which can be found on the PIC website. This form will require you to provide details about your claim, the reasons for the dispute, and any supporting evidence.
Once your application is submitted, the PIC will schedule a hearing. During the hearing, you will have the opportunity to present your case, including any additional evidence or arguments. The PIC will then make a determination on your review, which may include:
- Overturning the insurer’s decision and awarding compensation
- Modifying the insurer’s decision
- Upholding the insurer’s decision
It is important to note that the PIC’s decision is binding, and either party may have the right to review the decision to a higher court, such as the NSW Court of Review.
Gathering Additional Evidence
One of the key factors in a successful review is the strength of the evidence supporting your case. If your initial claim was denied, it is crucial to gather any additional evidence that may help strengthen your review.
This may include:
- Medical reports from your treating doctors or specialists
- Witness statements from colleagues, supervisors, or other relevant parties
- Copies of any relevant documentation, such as incident reports or medical records
- Expert reports or assessments, such as from occupational therapists or vocational rehabilitation specialists
- The more comprehensive and compelling your evidence, the better your chances of a successful review.
What to Expect During the Process
The reviews process can be lengthy and complex, but understanding what to expect can help you prepare and manage your expectations.
PIC Hearing
The PIC hearing is the central component of the reviews process. During the hearing, you and your lawyer will have the opportunity to present your case, including any evidence and arguments in support of your review. The insurer will also have the chance to respond and present their own evidence.
Seeking Legal Representation
While it is possible to navigate the reviews process on your own, it is generally recommended to seek the assistance of an experienced workers’ compensation lawyer such as ours. Gajic Lawyers can provide valuable guidance on the legal process, help you gather and present the most effective evidence, and represent you during the PIC hearing.
Conclusion
Although reviewing a workers’ compensation decision in New South Wales can be a difficult process, it is an important right for injured workers. If your compensation claim has been denied, immediately consult our team of specialists in compensation law.
Remember, the reviews process can be lengthy, so it is important to be patient and persistent. With our support at Gajic Lawyers, you can navigate the system and achieve a favourable outcome for your workers’ compensation claim. Consult us today for free!
