- The new system is designed to improve financial support for the most
seriously injured workers and provide more assistance and incentives for
injured workers to return to work when they have the capacity and it is safe to
do so. Under the New South Wales Workers Compensation Scheme, WorkCover is
providing injured workers with simple ways to seek review of decisions on their
capacity for work if they believe they have not been dealt with fairly.
Initially the worker can request an internal review from the insurer. Insurance
providers generally use a disputes and complaints management model that is
consistent with the Australian Standard on Complaints Handling.
If they
are not satisfied with the outcome of the review, they can then request a merit
review of the decision by WorkCover.
Following this, the worker can apply
to the WorkCover Independent Review Officer (WIRO) for a procedural review. The
WIRO is a key component of the workers compensation reforms, providing an
important accountability mechanism for the Scheme. It is an independent office,
which provides, among other things, an independent review of work capacity
decisions made about benefits and work capacity.
The WIRO is also
responsible for:
- investigating complaints made by workers about insurers, and making
recommendations for action to be taken by the insurer or the worker;
- reviews of work capacity assessment decisions made by insurers, after a
merit review by WorkCover and an internal review by the insurer;
- encouraging high quality complaint resolution by insurers and employers;
and
- inquiring into and reporting on matters arising in connection with the
workers compensation legislation.
The WIRO also includes the establishment
of a new Independent Legal Assistance and Review Service, which facilitates
access to free independent legal advice to injured workers, in circumstances
where there is a disagreement with insurers regarding entitlements. It has been
designed to ensure the efficient, fair and equitable resolution of disputes,
without unnecessary financial burden on injured workers. The Service is being
conducted by lawyers who have strong experience in workers compensation and are
independent of WorkCover.
- The changes to the Scheme introduced in June 2012 were vital for workers,
employers and the economy. The Scheme was in deficit and was not fulfilling its
core objectives well enough. The new legislation is focused on encouraging and
assisting early return to work, and providing better financial support for
seriously injured workers. The best protection for workers, employers, the
community and our economy is a financially sound scheme focussed on returning
injured workers to work where possible.
- An integral part of the workers compensation reforms is the introduction of
work capacity assessments. These are a multi-disciplinary assessment conducted
by the insurer, which review a worker's functional, vocational and medical
capacity to determine fitness for work. Work capacity assessments recognise
that recovery and return to work should be key priorities of any workers
compensation system.
- Work capacity assessments are multi-disciplinary, evidence based
assessments of a worker's functional, vocational and medical status. Should an
injured worker disagree with the findings of the work capacity assessment,
there are a number of avenues for review:
- Initially the worker can request an internal review from the insurer.
- If they are not satisfied with the outcome of the review, they can then
request a merit review of the decision by WorkCover.
- Following this, the worker can apply to the WIRO for a procedural
review.
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