The insurer has disputed liability for my workers compensation claim – what now?

*The contents in this blog relates to legislation in New South Wales.

There are multiple reasons why your employer’s workers compensation insurer might choose to dispute liability for your workers compensation claim. The good news is, a decision of an insurer to dispute liability is challengeable, and Turner Freeman Lawyers are here to help.

The first step to take when the insurer advises you that they are disputing liability for your claim is to ask them to send confirmation of the dispute in writing. They are required to do this, and it should set out their reasons for their decision.

Next, you should contact an Independent Review Office (‘IRO’) Approved Lawyer. IRO Approved Lawyers are eligible to receive funding through IRO to cover the legal costs associated with your claim. At Turner Freeman Lawyers, we have experienced IRO Approved Lawyers who would be pleased to assist you and obtain a grant to perform work on your claim as soon as possible.

Once you have engaged a lawyer, they will review the dispute notice and recommend the next steps to take. The relevant next steps will depend upon the nature of the dispute, and the reasons contained in the dispute notice. It may involve, for example, making some short submissions to the insurer, or obtaining further medical evidence, before requesting a review.

If you or your solicitor requests a review of the insurer’s decision to dispute liability for your claim, the insurer will have 14 days to respond to the request for review. If they do not respond within 14 days, or if they choose to maintain the dispute, your solicitors can lodge an application in the Personal Injury Commission (‘PIC’) on your behalf to have the matter determined by a Member of the PIC.

Once you have commenced proceedings in the PIC, you will likely be given a date for an initial teleconference. This is generally procedural in nature, and your solicitor will represent you. The purpose of the teleconference is to determine whether the parties are going to be able to resolve the dispute on their own, or if the matter needs to proceed, and if it needs to proceed, what next steps need to be taken.

Depending on the nature of the dispute, the Member may decide to refer the matter to a Medical Assessor. A Medical Assessor is a specialist doctor appointed by the PIC to provide an assessment to assist with any medical issues in dispute. They provide the PIC with a certificate, setting out their findings.

In other disputes, the Member may provide you with a date for a conciliation/arbitration conference. If you are provided with a conciliation/arbitration date, your solicitor will likely brief a barrister to appear for you. The conference is split into two phases. During the first phase, being the conciliation phase, the Member of the PIC will facilitate discussions between the party’s representatives in an attempt to resolve the dispute. If the matter cannot be resolved, it will proceed to the Arbitration phase, whereby the barristers for each party will make submissions before the Member and the Member will ultimately make a decision that is binding on the parties.

If a decision made by a Member following Arbitration is unfavourable to either party, they may appeal the decision, but only in very limited circumstances.

If you have received a dispute notice from your employer’s workers compensation insurer and you wish to challenge the decision, contact Turner Freeman Lawyers today.