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WIRO Wire | Reforms to commence with effect from 1 January 2019

Work Capacity Decisions 

Decisions made before 1 January 2019: 

For Work Capacity Decisions made before 1 January 2019 the present review method being the Internal, Merit and Procedural reviews  [1]  will continue including the restriction on injured workers access to legal advice (except for Merit Reviews).

This process will continue for a transition period of six months ending on 30 June 2019. After that all decisions whenever made will be reviewed under the new system.

Decisions made on or after 1 January 2019:

An injured worker will be entitled to receive legal advice to assist with the review of Work Capacity Decisions made by insurers after 1 January 2019 which will now be an internal review by the insurer or in the Workers Compensation Commission.

WIRO through the ILARS Scheme will provide funding for injured workers to receive independent advice about whether there are reasons why a Work Capacity Decision should be reviewed by the insurer or the Workers Compensation Commission. 

Insurers will still issue Work Capacity Decisions in writing to the injured worker as they do currently. There is no change proposed (on the information provided to WIRO) about the content of those Decisions.

Where an injured worker has not received twelve (12) weeks of continuous weekly payments there is a requirement to notify them in writing of the Work Capacity Decision (even on a provisional liability basis) however there is no need to issue a Section 78 Notice. That applies were the decision reduces the amount of the weekly payment.

Where an injured worker has received twelve (12) weeks of continuous weekly payments and the Work Capacity Decision reduces or discontinues the payment then the insurer is required to issue a Notice pursuant to Section 78 in addition to the Work Capacity Decision. The amended Regulation contains the information which must be contained in that Notice.

WIRO has issued a revised Funding Guide which may be found here.

The Workers Compensation Commission will issue an amended Form 1 (Expedited Assessment) which is to be used on behalf of injured workers to seek to have a Work Capacity Decision reviewed in the Commission.

Complaints and enquiries

All enquiries or complaints by or on behalf of injured workers about the conduct of their claim by the insurer will be solely dealt with by WIRO through its Solutions Group and the State Insurance Regulatory Authority (SIRA) will cease to consider those enquiries or complaints. This will include the concerns of exempt workers and coal miners.

[1. Section 44BB of the 1987 Act.]

Regards
Kim Garling
Workers Compensation Independent Review Officer

Christmas holiday closure
WIRO will be closed from 24 December 2018 until 2 January 2019. We wish you a happy Christmas and a prosperous new year.