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FAQs about Complaints and Enquiries

How can WIRO help me?

WIRO can help you if you have an issue with your workers compensation claim. You can contact us if you have a complaint or enquiry about your claim or insurer, if you need access to legal assistance or if you are unhappy with a work capacity decision by your insurer.

What can I make a complaint about?

You can contact WIRO if you have a complaint about an insurer that affects your entitlements, rights or obligations under NSW workers’ compensation legislation. This includes complaints about:

  • weekly benefits
  • denial or delays in determining liability
  • medical treatment.

I don’t agree with a decision of the insurer, what are my options?

Call us and we can help. We may be able to negotiate an oucome between you and the insurer.

My workers compensation claim has been declined

Call us on 13 9476 and we can discuss your options or find a lawyer near you for free, independent legal advice from one of our approved lawyers.

My weekly benefits have not been paid

Please ask yourself these questions before giving WIRO a call:

  • Have you provided a current Certificate of Capacity to your Insurer?
  • Have you provided your payslip if you are working?
  • Have you confirmed with the insurer that they have received the above information?
  • Has it been 5 working days since this information has been received by the insurer?

If you answered yes to these questions, contact us and we can contact the insurer for you.

I don't think the insurer is paying me correctly

Talk to your case manager first, they will be able to explain how your weekly benefits are calculated. If you still think you aren’t being paid correctly, contact us and we can contact the insurer and review how your weekly benefits have been calculated.

I’m having difficulties with the insurer – I can’t get in contact with them

Try sending your case manager an email and cc the insurer’s generic mailbox address, call the general number for the insurer or log your complaint online. If you still don’t get a response contact us and we can contact the insurer for you.

What is a work capacity assessment?

Work capacity assessments ascertain a worker’s ability to return to work following an injury in the workplace. The assessment by the insurer is a review of the worker’s function, vocational and medical status. In conducting a work capacity assessment consideration will be given to all available information including:

  • medical reports from your treating doctor or specialist
  • certificates of capacity
  • independent medical reports
  • Injury Management Plans
  • reports from a workplace rehabilitation provider such as workplace assessment reports, return to work plans, functional capacity evaluation reports, vocational assessment reports, work trial documents, job seeking logs, activities of daily living assessments, etc
  • information provided by the worker about their abilities.

You must attend and participate in any evaluation required as part of the work capacity assessment.

What is a work capacity decision?

Once you have been assessed, the insurer will make a work capacity decision. This decision is based on:

  • a worker's current work capacity
  • what constitutes suitable employment for a worker
  • the amount an injured worker is able to earn in suitable employment
  • the amount of pre injury average weekly earnings or current weekly earnings
  • whether a worker is, as a result of injury, unable without substantial risk of further injury to engage in employment of a certain kind because of the nature of that employment
  • any other decision that affects a worker’s entitlement to weekly payments of compensation, including a decision to suspend, discontinue or reduce weekly payments of compensation based on the points above.

Work capacity decisions will be made at many points throughout the life of a worker’s claim, for example on receipt of new information relating to the worker’s capacity for employment.

I've received a work capacity decision that I disagree with – what do I do?

We can explain what a work capacity decision is, advise you of the different steps of the review process and how you can challenge the decision.

My medical treatment or surgery has been declined

We can explain the options you have to challenge the insurer’s decision and put you in touch with free, independent legal advice if needed.

Can I request a new case manager?

WIRO can't change your case manager. However you can submit a formal request to the insurer outlining your reasons for the change and if appropriate the insurer may agree to it.

My claim has been closed however I now require surgery. Will the insurer cover this?

Should your circumstances change, you should notify the insurer with the relevant information from your nominated treating doctor. The insurer then has 21 days to make liability decision.

How can I get legal advice?

Find a lawyer near you to access free, independent legal advice from one of our approved lawyers.