Reviewing a rejected WorkCover Queensland psychological injury claim
You have 3 months from the insurer's written decision to apply for review with the Regulator, and the Regulator must decide the review within 25 business days.
s 542 of the Workers’ Compensation and Rehabilitation Act 2003 gives an applicant 3 months from receiving written notice of a decision (and the reasons for it) to apply for review. If the notice did not include reasons, the applicant must request them within 20 business days, the decision-maker then has 5 business days to provide written reasons, and the 3-month review clock starts from receipt of those reasons instead. An applicant can also ask the Regulator, once, for extra time, granted only where the Regulator is satisfied special circumstances exist.
What the Regulator does with a review application
Under s 545, the Regulator must review the decision within 25 business days of receiving the application and decide to confirm it, vary it, set it aside and substitute another decision, or set it aside and return the matter to the decision-maker. The Office of Industrial Relations, which handles this review, describes it as "not a court process": a Review Officer works from existing documentation and does not re-investigate or request further information.
Not every insurer decision is reviewable
The Office of Industrial Relations states plainly that not all insurer decisions can be reviewed. Decisions that are reviewable include accepting or rejecting a compensation application, terminating or suspending payments, increasing or decreasing weekly payments, and time-to-apply decisions. Decisions the Office of Industrial Relations lists as not reviewable include an insurer's ongoing management of a claim and a decision not to fund a particular medical procedure, though it notes some non-reviewable decisions may still be appealable to an Industrial Magistrate. Check which category your decision falls into before assuming the 3-month review path is the right one.