The NSW workers’ compensation scheme – and the legislation which supports it – is difficult to navigate at the best of times. Not only is the legislation itself difficult to navigate, but different legislation applies to different classes of workers. For example, Police officers, paramedics and firefighters are subject to different legislation to most.
For the vast majority of workers, the Independent Review Office (‘IRO’) provides legal costs funding to challenge adverse decisions made on behalf of iCare. This blog addresses common questions in relation to IRO funded workers’ compensation claims.
What do I do if my Claims Service Provider disputes all or part of my workers’ compensation claim?
Claims Service Providers (insurance companies who manage claims on behalf of iCare) make decisions about workers’ compensation claims every single day.
There are three types of statutory compensation available to workers in NSW, namely weekly benefits compensation, medical and treatment expenses, and lump sum compensation for permanent impairment. Your Claims Service Provider will make several decisions about your claim during its lifetime, and it is likely that some aspect of your claim will be disputed at some point.
These decisions include whether or not you are eligible for workers’ compensation, whether you are entitled to weekly benefits compensation, or whether the treatment you request is ‘reasonably necessary’.
Claims Service Providers routinely deny liability for claims either wholly or in part and they are obliged to notify you of their decision in writing. The written decision is what is known as a section 78 notice.
Further, Claims Service Providers routinely issue notices reducing weekly benefits called Work Capacity Decisions which can also cause you a lot of grief if you have less work capacity than your Claims Service Provider imagines.
If you receive a Section 78 Notice or other decision which you do not agree with it, you need to find yourself an IRO Approved Lawyer to help you challenge the Claims Service Provider’s decision.
What is IRO and what does it do?
IRO is the acronym for the Independent Review Office. IRO is an independent statutory office established in NSW under the Personal Injury Commission Act. It has several functions which assist injured workers:
- IRO provides legal costs funding to workers via the ILARS scheme
The ILARS scheme is administered by IRO. ILARS stands for the Independent Legal Assistance and Review Office. ILARS essentially pays your legal costs so that you can challenge adverse decisions made by Claims Service Providers. ILARS also pays your disbursements, such as the cost of a medico-legal report or obtaining clinical notes.
ILARS does not provide legal funding to challenge every disagreement or issue you may have with your Claims Service Provider. It only funds investigations and disputes about certain rights and entitlements under the Workers Compensation Act. For example, ILARS may provide legal funding to you if your Claims Service Provider unjustifiably denies liability for your injury or your medical and treatment expenses. Declining liability for surgery is one example.
Claims Service Providers make decisions every day which have little or no merit, and workers are successful in challenging those decisions if the evidence supports their claim.
ILARS will not provide legal funding to a worker who is unhappy because their rights and entitlements under the Act have legitimately ceased by law. IRO cannot change the law as unfair as that may be.
It is also important to note that ILARS will only grant funding via IRO Approved Lawyers who have demonstrated experience in the workers’ compensation arena.
It is crucial that if you have a dispute with your Claims Service Provider you consult an IRO Approved Lawyer as soon as possible.
IRO Approved Lawyers are lawyers employed by private law firms who are accredited by IRO to act in workers’ compensation matters.
An IRO approved lawyer will attempt to resolve your dispute with your Claims Service Provider and, if that is not possible, commence proceedings on your behalf in the Personal Injury Commission.
- How do I find an IRO approved lawyer?
The easiest and quickest way to find an IRO Approved Lawyer is to go to IRO’s website.
Click on the hyperlink that says FIND A LAWYER.
On the Find a Lawyer page, you can search for a lawyer by name, by firm or by region.
For example, if you live on the North Coast of NSW, you select that option in the dropdown box under Region and hit search. This will show you a list of all IRO approved lawyers on the North Coast. It is up to you to telephone an IRO approved lawyer on the list and consult them about your claim. The legal fees and disbursements charged by IRO approved lawyers are reimbursed by IRO and the worker does not pay a cent for legal representation.
- How do I access IRO funding for my legal costs?
Once you have consulted an IRO approved lawyer and they have agreed to take on your claim, your lawyer will make an application to IRO for a grant of funding for legal costs and disbursements. This is a straightforward process. If you make a claim for lump sum compensation for permanent impairment or there is a dispute about reasonably necessary medical treatment, IRO will fund a medico-legal examination and report with an approved medical specialist.
- What else can IRO do for workers?
You can complain to IRO if a Claims Service Provider is mismanaging your entitlements. Once a complaint is made, the Solutions Group contacts the Claims Service Provider to confirm the issues raised by you and acts as an intermediary to see if the issue can be resolved.
The IRO Solutions Group is very effective at resolving complaints made by workers and has an impressive track record.
An example of how the IRO Solutions Group may help is where a Claims Service Provider has failed to reimburse your medical expenses or failed to commence your weekly benefits compensation within statutory timeframes. The IRO Solutions Group does not deal with your general dissatisfaction with your claims manager. There has to be some failure on the part of the Claims Service Provider to fulfil its statutory obligations.
A complaint can be made to the IRO Solutions Group in two ways. The best way to contact IRO with a complaint is by using the online form on IRO’s website. If you are unable to complete the online form, you can email firstname.lastname@example.org or call 139 IRO (139 476).
If you are already represented by an IRO Approved Lawyer, it is best to ask them to assist you with your complaint.
If you have a workers’ compensation dispute and would like to discuss it with one of our IRO Approved Lawyers, call Bourke Legal on 1300 026 875 or reach out to us via our website.