The review decision
Once a decision on the application for review is made, it will be sent in writing to the applicant, other party and the insurer within 10 business days.
The potential outcomes of a review are:
- Confirm - the insurer’s decision does not change.
- Vary - the insurer’s decision is varied.
- Set aside - the insurer’s decision is changed and the insurer will take the necessary action.
- Set aside undecided - the insurer’s decision is set aside and the matter returned to them with specific instructions they must undertake prior to making a fresh decision.
If either party is unhappy with the outcome of a review decision, they are able to lodge an Appeal to the Queensland Industrial Relations Commission within 20 business days of receiving the review decision. .
If you are a worker and your claim has been rejected or terminated, all expenses incurred in relation to your review application will be at your cost. If you have incurred expenses obtaining a report from a medical practitioner, to provide for the review, and the outcome of the review is to set aside the insurer’s decision, you may be able to have the costs of a medical examination and report reimbursed by the insurer. This will not always occur as it depends upon whether the Office of Industrial Relations considers the medical examination and report substantially contributed to setting aside the insurer decision.
If you are an employer and the insurer accepted a claim that is overturned at review, you may be able to have certain costs removed from your policy. You will need to contact the insurer to discuss.
- Last updated
- 14 June 2019