What does 'grounds for review' mean?
Your grounds for review are the reasons you believe the Insurer
decision is wrong. Your grounds for review must be relevant to the
injury and the claim eg. The Insurer did not consider the
relevant medical information - You can then attach appropriate
material such as a new medical report.
Q-COMP cannot review Insurers' procedures or they way they
manage a claim, it is important that your grounds for review relate
to the injury itself.
By providing detailed grounds for review, it will help Q-COMP
better understand the issue.
What supporting information do I need?
Q-COMP conducts what is called an 'administrative review', this
means there will be no further investigations. Q-COMP will not
contact doctors, witnesses or specialists.
Any information that supports the injury should be provided with
your application for review. If you have any additional medical
reports, witness statements, payslips etc that support the issue
you are reviewing; it is crucial you submit them with the
application.
Q-COMP will make the review decision based on the information
the Insurer had at the time of the claim decision, and any
additional information provided with the review.
Does my review application and information get
sent to the other party?
Q-COMP is making an administrative decision and is obliged to
provide procedural fairness.
This means that it is likely that new information you provide
may be disclosed to the other parties impacted by the
information.
How long does a review take?
The decision is made within 25 business days unless we have
agreed to an extension. You and the other party with receive the
Q-COMP written decision within 10 days after the decision is
made.
The review decision will either:
- Confirm the original decision
- Vary the original decision
- Set aside the original decision and substitute another decision
or
- Set aside the original decision and return it to the Insurer
with directions
The 25 business day decision period can be extended only if
you:
- Agree to allow Q-COMP to obtain more information for your
application
- Apply for an extension to supply more information for your
application
What do I do if I am unhappy with the review
decision?
If you would like to dispute the review decision, the next step
is for you to consider the value of lodging an appeal of the review
decision.
If you decide to appeal you must lodge an Appeal with the
Queensland Industrial Commission against Q-COMP; the appeal must be
filed at the Queensland Industrial Relations Commission within 20
business days of receiving the Q-COMP decision.
If we don't make a decision within the 25 business days, or the
agreed extension timeframe, you can:
- Appeal to an Industrial Magistrate or the Queensland Industrial
Commission or
- Wait for the review decision to be made
What happens regarding expenses relating to the
claim?
Workers - If your claim has been terminated or rejected, all
expenses incurred in relation to your review application will be at
your cost. Should Q-COMP overturn the Insurer's decision, you may
be able to have the costs of a medical examination and report
reimbursed by the Insurer. This will not always occur as it depends
upon whether Q-COMP considers the medical examination and report
substantially contributed to the decision of Q-COMP to set aside
the Insurer decision.
Employers - You will need to arrange excess payments with the
Insurer, should we overturn the decision you will be reimbursed
from the Insurer. Policy or premium increases may be placed on hold
while the review takes place, you must negotiate this with the
Insurer.
Q-COMP does not review payments, this means we will not make
payments to claimants or reimburse medical treatment. If you are
financially suffering you may wish to contact CentreLink or your
superannuation fund.
What if three months has passed and I haven't
lodged my review?
There is no provision in the Workers Compensation
Rehabilitation Act 2003 for an application for review to
be lodged after the three months. However, in special
circumstances, you can ask QCOMP to extend the time,
provided you ask during the three month
period.
It is unlikely that requests to lodge review outside of
the three months will be agreed without any special
circumstances.
What if I require more time to lodge my
review?
Q-COMP has the discretion to grant extensions to applicants for
a review. A request for an extension of the three month timeframe
must be requested within the three months
and be supported by special
circumstances. The request must specify how long the
extension is required and the special circumstances/reasons as to
why you require an extension.
As the timeframe to lodge a review is three
months, it is expected that requests for the claim file, medical
appointments and medical reports are attended to during this three
month period, i.e. these do not constitute special
circumstances.
Once the extension request has been received, Q-COMP will make a
decision as to whether or not the extension is granted within 5
business days.
What is a Right of Appearance?
A right of appearance is the opportunity for the applicant to
meet the review officer and discuss their claim.
It is an opportunity for you in a non-threatening and non-legal
manner, to give us any additional information, point out a
particular issue or advise of any knowledge you have about your
case.
A right of appearance will not affect our review of the
Insurer's decision, and you may bring a support person.
However, all submissions regarding the review must be in
writing and the right of appearance discussions are not considered
as submissions.
Want more help? Please call
1300 739 021