If you are dissatisfied with the service you have received you can make a complaint through the Service Delivery Manager at Employers Mutual. Call (08) 8127 1100.

You can also contact WorkCover’s Service Improvement Unit by completing our online complaint form, calling WorkCover on 13 18 55 and asking to speak to our Service Improvement Unit, writing to the unit at WorkCover, GPO Box 2668 Adelaide 5001 or emailing SIU@workcover.com.

If you are dissatisfied with the management of your claim your first port of call should always be your case manager. If you are still dissatisfied, then you can ask to speak to their team leader, or following that, the Service Delivery Manager at Employers Mutual.

You can also contact WorkCover’s Service Improvement Unit and the WorkCover Ombudsman. If you have a problem relating to the operation of the WorkCover Scheme, you can contact the WorkCover Ombudsman who runs an independent office set up to investigate complaints. Call (08) 8463 6593 or toll free on 1800 195 202, or visit www.wcombudsmansa.com.au.

The case manager generally must make a decision about whether a claim is accepted or rejected within 10 business days of receiving the claim. If a claim has not been determined within a reasonable period (which will depend on the circumstances), you or your worker can apply to the Workers Compensation Tribunal for what is called an ‘expedited decision’. This means that the Tribunal gives Employers Mutual a time limit to make a decision. If this doesn’t happen, the Tribunal may determine the claim. This form is available from the Tribunal's website.

For more information on the Workers Compensation Tribunal, call (08) 8207 0999 or see the South Australian Industrial Relations Tribunal's website, www.industrialcourt.sa.gov.au.

If you are unhappy about a decision regarding a claim, you or your worker can lodge a Notice of dispute in the Worker's Compensation Tribunal. This form is available from the Tribunal's website.

The Tribunal has a structured system to resolve disputes once a Notice of Dispute has been lodged. A dispute can be resolved at any of the various stages, as follows:

• Reconsideration - When the Tribunal directs Employers Mutual to reconsider the decision.
• Conciliation - Compulsory conferences with the parties to try to negotiate a resolution.
• Judicial determination - A formal hearing where evidence is heard and arguments are put before a presidential member of the Tribunal. Legal representation is highly recommended at this formal stage.
• Appeal to the Full Bench of the Tribunal - Only on a question of law.
• Appeal to the Full Court of the Supreme Court - Only on a question of law with permission of the Supreme Court.

If the dispute involves a medical question, the Tribunal may refer the question for an opinion to Medical Panels SA (an independent body set up to provide opinions regarding workers compensation medical issues).

Medical Panels SA is an independent body specifically set up to deal with medical questions arising in workers compensation disputes. When a dispute involves opposing medical opinions eg, about a worker’s injury or capacity for work, medical questions may be referred to and an opinion provided by a medical panel. A medical panel is able to give an opinion on any medical question specifies in the Act. A medical panel will form its opinion within 60 days of a referral. For more information visit www.premcab.sa.gov.au.

You have a right to legal representation at any time and may choose to be represented by a solicitor or an employer advocate. Legal services are not free, although some of the cost may be recovered.

Business SA offers small business owners a free workers compensation representation service and can represent eligible employers at the Workers Compensation Tribunal.

To find out whether you qualify for the free service, phone :(08) 8300 0101 or go to:
http://www.business-sa.com/library/Workers Compensation Representation.pdf

You can request a report on a worker’s medical progress and incapacity for work. You can also request a copy of a worker’s medical reports relevant to the injury. For more information, speak to your case manager or see the relevant sections of the Act (107 and 107A). Or read the related links:

Australian Legal Information Institute (AustLII)
Occupational Health, Safety and Welfare (Safework SA) Amendment Bill 2005
WorkCover Corporation Act 1994
Workers Rehabilitation and Compensation Act 1986
Workers Rehabilitation and Compensation Regulations 1999
S107B Application for Access [439 KB]
Freedom of Information - Application for access [345KB]
Freedom of Information - Application for Review of Determination [341KB]
Freedom of Information Fees and Charges [60KB]