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What is a reconsideration?
A reconsideration is an independent review by Comcare, authorised under the SRC Act, of certain claim determinations. Comcare’s Disputed Claims team may independently undertake a reconsideration at the request of an employee (or their representative), employer or on its own motion.
Review Officers within Comcare's Disputed Claims Team independently review certain claim determinations for employees and employers. It is not a court process or a re-investigation of the claim. Some determinations that can be reviewed include:
- determinations to accept or deny a claim for compensation
- determinations to stop payment of compensation
- determinations to increase or decrease weekly payment of compensation
- an employer's determination in relation to rehabilitation of a worker.
- a reconsideration on own motion due to a re-determined period of incapacity
Disputed Claims cannot review administrative decisions made by Comcare including, but not limited to, the date of injury and the label of an accepted condition. A letter advising of an intention to make a determination is also not reviewable, rather an opportunity for you to respond to the intent or provide additional supporting evidence. If you are not sure whether a decision can be reviewed, contact your Claims Manager (CM) or Disputed Claims on 1300 366 979 or via email firstname.lastname@example.org.
Applying for a reconsideration of Comcare's determination within 30 days of receiving the determination
If you wish to clarify the reason for a determination further, you should contact the decision maker who can explain Comcare's decision in more detail. Once you have discussed the matter and if you remain dissatisfied with the determination made by Comcare, you can request a reconsideration.
When requesting a reconsideration you must include the reasons why you disagree with the determination. A Request for reconsideration can be made by an employee, their representative or an employer. Comcare cannot accept a request for reconsideration from providers or medical practitioners unless they are acting on your behalf and consent has been provided in writing.
As informed by the legislation, 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.
Considerations before requesting a reconsideration
Once a reconsideration request is submitted, the reconsideration process will commence with an aim to complete the decision within 30 days. If you need more time to obtain evidence in support of your request for reconsideration, you should contact Disputed Claims and ask for an extension of time to submit the reconsideration.
You can write to us, email at email@example.com 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 or evidence within the specified 30 day timeframe. Comcare may request you provide evidence in support of an extension of time request.
Disputed Claims need to know what information you intend to provide, when you will provide it by and the purpose of the information. Disputed Claims 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.
How to lodge your reconsideration
You can lodge a reconsideration request by completing a Request for Reconsideration form. You should attach a further statement or supporting evidence to the form if you have any.
Note: you do not need to provide copies of documents contained in your claim file. The Review Officer will have access to all documents held on your claim files when reviewing the determination.
The form can be emailed to firstname.lastname@example.org, faxed to 02 6274 8838 or you may 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 Disputed Claims receiving the request.
You must provide the following details for your request for reconsideration to be valid:
- the date of the determination; and
- the reason why you do not agree with that determination.
What happens next?
When Comcare receives your reconsideration or internal review 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. Reconsideration outcomes are 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 or internal review 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 discuss your request or 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 30 days from the date that Comcare receives the reconsideration request, or the date the last piece of evidence is received. The 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.
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 will decide on one of the following:
- 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.
An internal review will decide on one of the following:
- affirm – no new decision is issued and you may apply to the AAT
- revoke – move to issue a new ROM.
The decision will be sent to you via your preferred method of contact, either post or email. If you would like to change your preferred method of contact for the reviewable decision please contact your allocated Review Officer or Claims Manager to advise of this change.
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.