There are strict timelines attached to a number of key areas under the Queensland workers’ compensation scheme.
LODGING AN APPLICATION FOR WORKERS’ COMPENSATION
Under the Queensland scheme, a claim for workers’ compensation must be lodged within 6 months of the worker being diagnosed as having sustained a work-related injury or illness.
The diagnosis that the injury or illness is work-related must be made by either a doctor or if it is an oral injury, by a dentist.
An injured worker should lodge a claim as soon as possible after sustaining a work-related injury.
If an application is lodged more than 20 business days after the diagnosis, compensation will be limited to commence no earlier than 20 business days before the application was lodged.
EMPLOYER’S DUTY TO NOTIFY WORKCOVER OF AN INJURY
If a worker sustains a work-related illness or injury, the employer must notify WorkCover within 8 business days after the first of the following occurs:
- Employer is aware of the worker’s injury
- Worker advises the employer of an injury
- Employer receives written request from WorkCover for report
This does not apply to self-insurers.
MAKING A DECISION ON AN APPLICATION FOR WORKERS’ COMPENSATION
The Workers’ Compensation & Rehabilitation Act 2003 determines the insurer must make a decision on an application for workers’ compensation for a physical or psychological injury within 20 business days after the application was made.
If the insurer has not made a decision within the 20 business day period,the insurer must within 5 business days after the end of the time notify the injured worker of its reasons for not making a decision.
The injured worker can lodge a review application with the Workers' Compensation Regulator if an insurer has not made a decision within the legislated timeframes, however this does not necessarily mean the claim will be accepted.
Once the insurer has made a decision on an application for workers’ compensation they must provide to the injured worker their written reasons for the decision within 5 business days of the injured worker’s request.
OBTAINING A COPY OF A CLAIM FILE
The injured worker can request a copy of their claim file which the insurer must release within 20 business days of the request unless there is a reasonable excuse not to release the file, including :
- Information on the file is protected by legal professional privilege
- would alert claimant to investigation of fraud
- matter contained in the document would meet the requirements of Freedom of Information
- the insurer suspects worker or claimant requires document for the purpose prohibited ins572A
Only the injured worker or a person acting on their behalf can obtain an injured worker’s claim file.
The employer can request information which may be on the file be provided to them if it is in relation to the injured worker’s rehabilitation or capacity to work.
The employer may also have received information from the injured worker’s claim file under the principles of natural justice.
If the insurer’s decision has been to either accept, reject, cease or suspend an application for workers’ compensation, the injured worker can lodge a review application within 3 months of receiving written notice of the decision. Review applications are lodged with the Workers' Compensation Regulator.
Once an Application for Review has been lodged, the Regulator must make a decision on the review within 25 business days.
Upon making a review decision the Regulator must give the injured worker, the employer and the insurer written notice of the review decision within 10 business days.
If an injured worker or employer disagrees with a Regulator review decision an appeal must be lodged in the Queensland Industrial Relations Commission within 20 business days of receiving the review decision.
If the appeal is about an insurer's a decision which is non-reviewable, the appeal must be lodged in the Industrial Magistrates Court within 20 business days of receiving the notice of the decision.
An injured worker should contact their union or seek legal advice before proceeding with an appeal.