Work Capacity Decisions made on or after 1 January 2019
If an injured worker needs assistance about a work capacity decision made on or after 1 January 2019 they can call IRO on 13 9476.
Work Capacity Decision made before 1 January 2019
Apply for a procedural review
To apply for a procedural review complete this form.
When to apply for a procedural review
A worker can apply to IRO for a procedural review of a work capacity decision made before 1 January 2019. Procedural reviews are only available after an internal review has been carried out by the insurer and a merit review carried out by SIRA.
What is a work capacity decision?
Work capacity decisions are decisions that affect the amount of weekly compensation payments an injured person claiming workers compensation is entitled to. This can include decisions such as:
- whether an injured worker has a capacity to work
- the type of work suitable for an injured worker
- the amount an injured worker is able to earn in suitable work
- the amount of an injured worker's pre-injury earnings, or the amount of their current earnings
For work capacity decisions made before 1 January 2019, injured workers have the right to ask the insurer for an internal review of their work capacity decision. If a worker disagrees with the decision, they can then ask for a merit review of the decision by SIRA. If the worker disagrees with SIRA’s recommendations the worker can then seek a procedural review by IRO.
Step 1: internal insurer review
You have the right to ask the insurer to review a work capacity decision. You should make this request by completing the Application for internal review by insurer provided by SIRA. This form must be provided to your insurer as soon as possible.
Step 2: Merit Review Service
If you are not happy with the outcome of the internal review you then have the right to ask SIRA for a review of the merits of the decision. You should make this request by completing the Application for merit review by SIRA and provide it to SIRA within 30 days from receiving the insurer’s decision.
You may seek assistance from a legal practitioner regarding an application for merit review by SIRA. From 16 December 2016 the insurer is liable to pay costs for legal advice given in connection with an application for merit review of a work capacity decision.
Please note, legal costs will not be payable if you seek legal advice more than 30 days after you were notified of the internal review decision.
Step 3: IRO procedural review
If your issue is still not resolved after the above 2 steps, you then have the right to ask IRO to review the insurer’s procedures in making the work capacity decision. IRO will not inquire into the merits of the original decision or the merit review recommendations.
You should make this request by completing the Application for procedural review. An application for procedural review must use this approved form. You must lodge the application within 30 days from receiving SIRA's merit review decision or your application will not be valid.
Once you have completed the application for procedural review scan and send the form to IRO at firstname.lastname@example.org.
Any decision made by IRO is binding.
What information do I need to provide?
You do not need to provide any information or documentation other than that provided in the Application for procedural review. IRO will request the relevant information required directly from the insurer.
Who can help with your application?
You can get help from anyone including:
- Your insurer
- A union representative
- An interpreter
- Your employer
- Your legal representative
- A support person
A lawyer is not able to receive payment for providing advice or assistance with respect to procedural review by IRO.