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Injured Workers Support Network
Fact Shee
Work Cover Independent Review Officer The Workers Compensation Legislation Amendment Act 2012 establishes an independent external complaints resolution mechanism through the appointment of an independent statutory office, the WorkCover Independent Review Officer (WIRO). WIRO is responsible for: * Investigating complaints made by workers about insurers where their entitlements, rights or obligations are affected, and making recommendations for action to be taken by the insurer or the worker * Reviewing work capacity decisions by insurers * Encouraging high quality complaint resolution by insurers and employers * Administering the Independent Legal Assistance and Review Service. (ILARS) * Reporting annually to the Minister and the Parliament on their responsibilities WIRO helps injured workers deal with complaints about a decision or action taken by an insurer that affects their entitlements, rights or obligations under NSW workers compensation legislation. This includes complaints about denial of liability by the insurer. Who can make a complaint? You can make a complaint to WIRO if you are an injured worker and you are not happy with a workers compensation decision made by your insurer. When should you contact WIRO? Before contacting WIRO, you should first try to resolve your complaint with the insurer directly. What will WIRO do? WIRO will investigate complaints fairly by listening to both sides of the story and looking at the facts. At this point, we can work out what action, if any, should be taken. We will then contact all parties to discuss our recommendation. How does WIRO do it? After you contact WIRO, they will: • Review the facts and circumstances • Contact the insurer on your behalf to obtain any further information we may need • Attempt to resolve the complaint or • Investigate, report and make a recommendation then follow up on it. IWSN Fact Sheet WIRO. Correct as of April 2015 What information do you need to provide? When you call WIRO, please have: • Your claim number • Your contact details • As much information as you can provide about your complaint. How long will it take? Allow about 30 days from the date you contact WIRO to resolve your complaint. If it is going to take longer than this, we will let you know how long and why. If our team thinks that your complaint raises legal issues, the matter will be referred to the Independent Legal Assistance Review Scheme (ILARS) to help you access legal advice. YOUR RIGHTS NEXT STEP You have the right to ask the You should make this request by completing the insurer to review a decision that Application for a Review by Insurer form and provide it it has made about your work to your insurer within 30 days. capacity. If you still believe that the insurer has not applied the correct approach: You have the right to ask WorkCover for a review of the merits of the decision. Completing the WorkCover Application for a Review by the Authority form) and provide it to WorkCover within 30 days after receiving the insurer’s decision. For more information about WorkCover’s merit review, click here. If your issue is not resolved following the WorkCover review: You can seek assistance with the completion of your application from anyone, including: You have the right to ask WIRO to review the insurer’s procedures in making the work capacity decision. The WIRO decision is binding. •
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Your insurer A support person A union representative An interpreter Your employer Your legal representative. A lawyer is not entitled to be paid for helping you to complete your application. FOR HELP If you have any questions call WIRO on 13 9476 or email complaints@wiro.nsw.gov.au. Information taken from the WIRO website April 2015. IWSN Fact Sheet WIRO. Correct as of April 2015