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Reconsiderations and reviews

Comcare's Reconsiderations Team independently reviews certain claim determinations for injured employees and employers. It is not a court process or a re-investigation of the claim. Some determinations that can be reviewed include:

  • decisions to accept or deny a claim for compensation
  • decisions to stop payment of compensation
  • decisions to increase or decrease weekly payment of compensation
  • an employer's decisions in relation to rehabilitation of a worker.

The Reconsiderations Team cannot review administrative decisions made by Comcare. Some examples include the date of injury and the label of an accepted condition. A letter advising of an intention to make a decision is also not reviewable. If you are not sure whether your determination can be reviewed, call your Claims Services Officer (CSO) or the Reconsiderations Team on 1300 366 979.

Comcare's reconsideration service is free. However, you will be responsible for the cost if you choose to ask a solicitor or another person to assist you in preparing your Request for reconsideration or Administrative Appeals Tribunal (AAT) review application. For information about a solicitor who may be able to help you, contact the Law Society in your state or territory.

Apply for a reconsideration of Comcare's determination within 30 days of receiving the determination

The reasons for the determination made by a CSO help you to understand Comcare's decision. If you do not understand the determination, you should discuss it with the decision maker. If you do not agree with a claim determination made by Comcare, you can request a reconsideration. A Request for reconsideration can be made by either an injured employee, their representative or an employer. Comcare cannot accept requests for reconsideration from providers or medical practitioners unless they are acting on your behalf.

A Request for reconsideration must be made within 30 days of receiving the determination.

As you will have limited opportunity to provide further evidence to Comcare once your request is received, you should submit any new evidence when you make a request for reconsideration of the determination.

If you need more time to obtain evidence to supply in support of your request for reconsideration, you should ask for an extension of time to submit the reconsideration. Once a reconsideration request is submitted, the reconsideration process will commence.

If you need an extension of time to lodge your Request for reconsideration, you can write to us, email reconsiderations.team@comcare.gov.au or call us on 1300 366 979. In order to consider your request for an extension of time, you will need to provide Comcare the reasons you are unable to submit your request within the specified 30 day timeframe. Comcare may seek evidence in support of an extension of time request.

The Reconsiderations Team will need to know what information you intend to provide, when you will provide it by and the purpose of the information. The Reconsiderations Team will assess your request and advise you if your request is approved or not. If your request is not approved, the Review Officer will advise you of the reason. Comcare may request evidence to support your extension of time request.

You can lodge a reconsideration request by completing a Request for reconsideration form. You may choose to attach a further statement or supporting evidence to the form. The form can be emailed to reconsiderations.team@comcare.gov.au, faxed to 02 6274 8838 or post it to GPO Box 9905 Canberra ACT 2601. It is recommended that you use the form or email your request to prevent delays in the reconsideration team receiving the request.

You must provide the following details for your request for reconsideration to be valid:

  • the date of the determination
  • details of why you do not agree with that determination
  • any new information that you may have (for example, statements, medical reports or x-rays).

What happens after I request a reconsideration?

When Comcare receives your reconsideration request it will:

  • allocate the reconsideration to an independent Review Officer
  • acknowledge the request for reconsideration to all parties;
  • provide an opportunity for the responding party to comment on new evidence and information.
  • assess any new evidence you provide, along with all relevant evidence on the claim file, in line with the SRC Act
  • in limited circumstances, request any necessary additional information
  • issue you with a decision in writing, which is known as a "reviewable decision."

Where new evidence has been presented, the other affected party will be provided a period of time to respond to the request for reconsideration and the process will commence.

Will I have an opportunity to discuss my concerns with Comcare?

If you wish to draw the Review Officer's attention to particular documents on the claim file, you should do so in your request for reconsideration. Alternately your Review Officer can also answer any questions you have about the reconsideration process over the phone.

Will my employer be involved?

Your employer will receive a copy of your request and any additional information you provide during the reconsideration process. Your employer may be invited to respond to any new evidence or provide comments regarding your request.

Your employer has the same rights to request a reconsideration of a claim decision. Comcare will notify you if your employer requests a reconsideration of a claim determination and will provide you with a copy of the request and any information provided by the employer.

Will the Review Officer re-investigate my claim?

A reconsideration is conducted 'on the papers'. This means that your Review Officer will review all relevant documents on the claim file and any additional information provided during the reconsideration process.

Comcare will not re-investigate your claim on review. However, in limited circumstances where clarification is needed, the Review Officer may request additional information, and will inform you of this request. Comcare will give you a copy of any information it receives in the reconsideration process.

How long will it take to complete a reconsideration?

The reviewable decision is expected to be completed within a maximum of 60 days from the date that Comcare receives the reconsideration request. The Reconsiderations Team aim to have a decision made earlier but your Review Officer will be the best person to provide advice on the expected timeframe.

If Comcare is unable to meet this timeframe, we will contact you to advise you of the delay, including the reasons for it.

Outcome

When all relevant information has been received by Comcare, the Review Officer will complete the reconsideration and issue a decision, which is known as a reviewable decision.

Comcare provides the reviewable decision in writing. A reviewable decision can do the following in relation to a claim determination under review:

  • affirm - the determination under review does not change
  • vary - the determination under review is changed in some way
  • revoke - the determination under review is overturned and replaced with the reviewable decision.

If you wish to have your reviewable decision emailed to you, please advise your Review Officer and provide your email address either during the reconsideration process or when they advise you that your reconsideration has been completed.

What if I am not happy with the outcome of the reconsideration?

If either party disagrees with Comcare's reviewable decision, then either party may apply to the Administrative Appeals Tribunal (AAT) for a merits review of the reconsideration by lodging an Application for review with the AAT.

An Application for review must be lodged with the AAT within 60 days from the day the reviewable decision is received. The details for the AAT registry in your state will be provided in the reviewable decision.

More information regarding the AAT can be found at their website.

Privacy, confidentiality and natural justice—the fine print

Comcare needs to collect and store personal information in order to review a claim determination. When you sign your claim form, you give us permission to collect, store and use your information to make decisions in relation to your claim. Comcare is obliged by Federal law to share certain information with a worker and their employer on request. Comcare can also obtain information from a worker or their employer by request under Federal law.

Natural justice means a party who may be affected by a proposed decision must be afforded an opportunity to respond to new information relating to the issue. If you believe the information you provide to Comcare is covered by a genuine legal obligation of confidence, please tell us in writing. You should be aware that there may be circumstances when we still need to reveal the substance of the confidential information to another party.

Contacting the Reconsiderations Team

You can call Comcare's Reconsiderations team on 1300 366 979 or email us at reconsiderations.team@comcare.gov.au

Can I provide my feedback

If you have feedback on how the Reconsiderations Team have handled your claim or Request for reconsideration, please refer your enquiry to a Senior Review Officer or the Assistant Director, Disputed Claims.

Alternately, you can email feedback@comcare.gov.au.

Page last updated: 11 Feb 2016