Regulatory services and performance

Targeted Rehabilitation and Return to Work (RRTW) Audit Campaign

The targeted audit of all insurers’ rehabilitation and return to work plans and Final Audit report is complete. Results have been shared with scheme stakeholders and are published on the WorkSafe website.

The audit was designed to assess how well Queensland insurers were meeting their obligations in relation to RRTW plans and identify areas of better practice and opportunities to improve return to work outcomes.

The audit did not assess the standard against the new laws that commenced on 23 August 2024 (requiring plans to be developed in 10-day timeframe).

5 out of 29 audits met minimum requirements. 24 audits identified instances where plans were not being developed, were not maintained, were not developed in consultation with the worker, employer and treating providers or were not shared.

Overall, findings show:

• 39 per cent did not have RRTW plan
• 90.4 per cent had RRTW plans that included the objective and steps to reach the objective
• 76 per cent had maintained the RRTW plan
• 73 per cent - the insurer had shared a copy of the RRTW plan with the worker, employer and treating medical provider.

In addition to addressing performance directly with insurers through a range of regulatory tools including risk profile ratings, improvement action plans and quality assurance programs, steps are being taken to support insurer compliance and improvement with updated guidance and education for insurers including a frequently asked questions document to capture commonly asked questions/scenarios.

Scheme data confirmed that the scheme’s return to work rate for finalised time lost claims has reduced from 90.9 per cent in 2023-24 to 90.3 per cent. Further, the rate reduces to 82.4 per cent for workers who have 4 or more weeks off work.

Investigations

119 reports of suspected offending under the Workers’ Compensation and Rehabilitation Act 2023 were made to the Regulator.

Most reports related to suspected fraud and provision of false information. Other reports received included reports of non-compliant law practice certificates, claim farming, misuse of workers’ compensation documents and employers taking action to avoid the compensation process.

25 investigations were finalised, with prosecutions commenced against 3 parties as a result of those investigations.

Notable prosecutions

Employer fined for using email from insurer to terminate workers’ employment

An employer was fined $5,000.00 for using an email received from WorkCover which summarised a medical report to terminate a worker’s employment. Read more

Man who worked as Uber driver during his claim convicted of WorkCover Fraud

A worker who lied about working as a Uber driver for 10 months during his workers’ compensation claim has been sentenced to 18 months' imprisonment (wholly suspended for 2 years) and ordered to pay $64,651.95 in restitution.  Read more

Dispute resolution services

Medical Assessment Tribunals

In 2023-24, tribunal referrals increased by 11.4 per cent to a total of 3,773 referrals received. Between 1 July and 31 December 2024, referrals have continued an upward trend and were 26.3 per cent above 2023-24 YTD.

In 2023-24, 650 tribunal referrals (17.2 per cent) were cancelled and returned for insurer action for not meeting mandatory referral requirements as set out in the Medical Assessment Tribunal - Referral Guidelines. These referrals are often resubmitted which contributes to the rise in referral numbers.  Common reasons for cancellation include over period of time dates not provided, diagnosis not updated with current reports and progress reports within 6 months not provided or insufficient.  As at 31 December 2024, 367 referrals have been cancelled (16.7 per cent).

The average duration from date of registration until a tribunal hearing increased from 42 business days in 2023-24 to 54.6 business days.

Strategies continue to be implemented to manage increased referrals and reduce timeframes and impacts for workers, insurers and the scheme. These include weekly monitoring, additional resources, maximising internal resources to prioritise triaging of referrals, undertaking early mandatory document checks and educating insurers on quality referrals, as well as intensive hearings.

Business improvement initiatives also being implemented to ensure efficient work processes and to expedite the validation process and booking timeframes include a review of intensive hearing guidelines, upgrading dictation software and insurer portal system upgrades to the online MAT referral form.

To minimise harm for workers, insurers and the scheme, priority referrals continue to be expedited.

An insurer or worker can request consideration to prioritise a referral due to a risk of potential psychological harm or financial welfare concerns by emailing their request to mat@oir.qld.gov.au or phoning 1300 738 197.

Specialty and General Medical Assessment Tribunals recruitment

The Medical Assessment Tribunals make independent, expert medical decisions about work-related injury or impairment.

A recruitment process is underway to fill positions expiring on 30 June 2025 within certain Specialty Medical Assessment Tribunals and to fill vacancies within the General Medical Assessment Tribunal due to the retirement of some specialists.

Applications for appointment to the Specialty Medical Assessment Tribunals and the General Medical Assessment Tribunal opened on 28 January 2025 and closed on 14 March 2025.  Further details can be found at https://www.worksafe.qld.gov.au/mat.

Review and Appeals

The Review Unit continues to implement strategies that are increasing productivity, with a further 7.6 per cent increase in average monthly reviews finalised for 2024-25 (on top of a 22.6 per cent increase in 2023-24).

Reviews continue to be managed efficiently with the average duration to decide reviews once allocated to a review officer stable at around 16 days.

Strategies implemented to maximise Review Unit productivity include:

• additional resources and maximising outsourced legal services
• a project team implementing recommendations from an independent review of the Review Unit’s operation and supporting implementation of relevant findings and recommendations of the 2023 five-year review
• business process improvements
• regular engagement with insurers to support improved quality in decision-making and to understand disputation rate trends.

The Review Unit continues to respond to increasing service delivery demands, with a further 5.5 per cent increase in review applications in 2024-25 (on top of the 22.7 per cent increase in 2023-24). This continues to contribute to delays in allocating and finalising reviews within the 25-business-day timeframe.

Contact the team on 1300 739 021 if a matter requires prioritising due to a risk of potential psychological harm or financial welfare concerns for the worker.

While the rate of reviews going on appeal is stable, the higher output of reviews is contributing to appeals continuing an upward trend, with an 11.7 per cent increase in 2024-25 (on top of a 22.9 per cent increase in 2023-24).

The Appeals Unit is implementing resource and administrative strategies to manage increasing caseloads resulting from the increase in appeals lodged.