You can’t challenge the decision to decline liability unless the decision is in a Section 74 Notice.
The Section 74 Notice is named after section 74 of the Workplace Injury Management and Workers Compensation Act 1998. This section requires an Insurer to give notice and a statement of reason as to why they are disputing liability for a claim.
The section 74 Notice must include the following;
- A copy of all documentation (including medical reports) relied on to arrive at the decision to decline liability.
- Set out the reasons why liability has been declined.
This must be done in writing and sent to the injured worker.
A Section 74 Notice must be sent each time the insurer declines either weekly payments or declines to pay for some treatment expense.
More often than not the insurer will just tell an injured worker over the phone that they are not going to pay for any further physiotherapy (for example) and not send out a Section 74 Notice. This is in contravention of the legislation.
If this happens you must ask the insurer to put the reasons in writing and if they refuse to do so contact Workcover on 131 050 and report the insurers conduct.
The insurer must also provide information to the worker about obtaining a review of the decision to dispute liability. It must also provide information to the worker about obtaining advice from a lawyer or other organisation such as WorkCover.
You can request an internal review by the insurer however in our experience this is usually pointless as we haven’t yet seen an insurer change their mind!
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