Workers’ compensation complaints
The Workers’ Compensation Regulator (Regulator) is responsible for regulating the Queensland workers’ compensation scheme. This includes monitoring the performance of WorkCover Queensland and self-insurers and ensuring they comply with workers’ compensation laws.
What types of complaints can the Regulator assist with?
- Claims management matters such as the inconsistent application of claims process, timeliness of decision-making, rehabilitation and return to work planning, misinterpretation of medical information, lack of support services provided or insufficient communication.
- Insurer complaints management matters or complaint investigation outcomes.
What types of complaints can’t the Regulator assist with?
- Complaints about certain claim decisions made by an insurer can only be reviewed through an independent review or appeals process.
- Complaints about an outcome of a non-reviewable insurer decision may be appealable to an Industrial Magistrate. For more information, please refer to Appeals.
- Work health and safety or electrical safety matters can be reported using the Raise a workplace safety concern form.
- Complaints about a health service, health service provider or health support service in Queensland can be reported to the Office of the Health Ombudsman.
- Industrial relations matters such as underpayment of wages and other entitlements can be reported to the Fair Work Ombudsman.
- Allegations of suspected corrupt conduct must be reported to the Crime and Corruption Commission.
- Human rights complaints can be reported to the Queensland Human Rights Commission.
If you have concerns about the behaviour or conduct of a workers’ compensation insurer (other than a reviewable decision), you should first try and resolve these with your insurer:
- Make a complaint to WorkCover Queensland.
- Make a complaint to a self-insurer.
If you have lodged a complaint with your insurer and are not satisfied with the outcome, you can escalate your complaint to the Regulator.
We will acknowledge receipt of your complaint within 3 to 5 business days of receipt.
You will need to provide information including the insurer’s written response to your complaint.
Your complaint will be reviewed, and we will confirm in writing whether we intend to take further action.
Depending on the nature of your complaint, we may decide to investigate the complaint, direct the insurer to take specific action, take no further action, or take regulatory action.
In some instances, we may intervene without concerns first being raised with the insurer. Examples of when we may do this include delays in payment of weekly compensation that has been accepted but not ceased, when a worker is in acute psychological distress, and delays in rehabilitation and/or medical treatment.
The Regulator is responsible for undertaking a review of certain insurer decisions under the Workers’ Compensation and Rehabilitation Act 2003.
If you are unhappy with a reviewable decision made by an insurer, you can lodge an application for an independent review of the decision.
Strict time limits for lodging an application apply. Your application must be lodged within 3 months of receiving the insurer's written decision.
If you have evidence of fraud or other serious offending under the Act, this must be reported for further investigation by completing the online form:
Complaints about an employer or workplace rehabilitation provider should be raised with an insurer directly.
An insurer is responsible for educating and supporting employers to understand and meet their legal obligations e.g. relating to rehabilitation and return to work or suitable duties.
They also have contractual arrangements with workplace rehabilitation providers and medical specialists engaged to deliver services.
The Queensland Ombudsman has the power to investigate the decisions and actions of Queensland state government departments, local councils and public authorities.
If your complaint with WorkCover Queensland or the Regulator is unable to be resolved directly, you can request an external review by the Queensland Ombudsman.
More information about the role of the Queensland Ombudsman can be found on their website.