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Disputes

An injured worker has the right to challenge and dispute certain decisions made by the claims agent or self-insurer.

For example, an injured worker can dispute decisions about:

  • the determination of a claim for compensation
  • average weekly earnings
  • permanent impairment assessments
  • the payment of medical treatment
  • the nature of the rehabilitation he or she is offered.

A decision is challenged by lodging a notice of dispute in the Workers Compensation Tribunal, an independent arm of the judiciary established specifically to hear disputes about workers compensation. When a decision is challenged, the first step is for 'internal reconsideration' to take place, whereby someone other than the initial decision-maker reviews the decision. If the decision is confirmed and the worker wishes to proceed with the dispute, the matter is referred to conciliation.

Note: a decision on provisional payments cannot be disputed at the Tribunal. The injured worker who is unhappy about the decision needs to request a claim determination.

The steps taken at the Workers Compensation Tribunal are:

  • conciliation – if unresolved, then:
  • judicial determination – single judge, if appealed, then:
  • Full Bench of the Tribunal – three judges, on a point of law:
  • following the Full Bench of the Tribunal, it is possible to appeal the matter on a point of law to the Full Court of the Supreme Court, with permission.

Medical panels

Where a dispute involves a medical question, it must be heard by the independent body, Medical Panels SA. The Act specifies 17 medical questions, and if one of these matters is in dispute the question must be resolved by a panel of independent doctors appointed by the Convenor of Medical Panels SA. The decision of a Medical Panel on the medical question is final and conclusive and cannot be appealed.

WorkCover Ombudsman

The Office of the WorkCover Ombudsman provides free advice and assistance to injured workers, employers and other interested parties who have a complaint about the way services are delivered in the WorkCover Scheme.

It is an independent office that investigates complaints about the operation of the WorkCover Scheme and reports problems with the Scheme to the Minister for Industrial Relations.

The Ombudsman can implement the 'safety net' for injured workers, testing the reasonableness of decisions to stop weekly payments. To contact the Office of the WorkCover Ombudsman please phone (08) 8463 6593, email owo@sa.gov.au or visit the website www.wcombudsmansa.com.au.

Download WorkCover Ombudsman fact sheet