Have you ever felt, as an employer, that a workers compensation claim should not have been accepted by WorkSafe agents?
It’s a frustration that many employers have had, but improvements are on hand in Victoria, thanks to agreed arrangements between Australian Industry Group and WorkSafe.
We have worked together to make the process of questioning decisions about workers’ compensation claims clearer and easier.
In a major step forward, where an employer feels a claim by an employee should not have been accepted, WorkSafe in Victoria and Australian Industry Group have formalised a process that allows employers to seek a review of, and reasons for, claims acceptance decisions.
This includes a clear pathway for employers to raise concerns with the Agent, and if necessary escalate the matter to WorkSafe.
The process acknowledges the important role employers play in decision-making and was developed after extensive discussions between WorkSafe and Australian Industry Group.
“We listened to member concerns about issues with questioning claim acceptance decisions and approached WorkSafe to help deal with the issue," Australian Industry Group Victorian Head, Tim Piper, said.
"Employers have always been able to raise concerns about claims acceptance decisions. However the process was informal and not widely known, but now, it is formalised and documented," he said.
Under the process, if an employer disagrees with a decision to accept a claim, they should first raise the matter with the Agent and request a review of the decision. The Agent must consider any concerns raised and provide a written response outlining the outcome and reasons for the decision. .
If the employer is still not satisfied, they can escalate the matter to WorkSafe. Where appropriate, WorkSafe will provide a written response after considering the concerns raised.
To support this, WorkSafe has added a new section to its Online Claims Manual titled Employers and eligibility decisions. This section outlines expectations for Agent transparency and employer involvement.
It also confirms that employers who disagree with the acceptance of a claim can request a review by the Agent. If the matter remains unresolved, they may escalate the matter to WorkSafe. In limited circumstances, employers may also lodge a formal objection with WorkSafe. This process is now clearly documented in WorkSafe's guidance.
"Australian Industry Group sees this as a positive development that reflects WorkSafe’s willingness to listen to our views. We raised the issues because members told us they had problems with questioning claim acceptance decisions. We expect this clarity will support our members to do this more easily," Mr Piper said.
WorkSafe is currently working with Australian Industry Group to create a simple information sheet explaining the new guidance. This will be available soon on our website – so watch this space .
