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Applying for a reconsideration of a determination

For: Claimants Advocates

You or your employer can request a reconsideration of a primary determination made under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).


Reconsiderations explained

If you would like to clarify the reason for a determination that was made on your claim, you should contact your claims manager.

If you disagree with the determination that has been made, you can request that it be reconsidered. You can also request an alternate dispute resolution method that may allow you to resolve a claims-related dispute.

What a reconsideration involves

Reconsiderations are carried out by a review officer who was not involved in making the primary determination.

A reconsideration is an internal review of a determination made under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).

It is not a court process. It is a second look at the information and evidence on the claim to ensure the correct determination was made. The review officer can consider whether all relevant information was obtained and request additional information if necessary.

A reconsideration of own motion is when a claims manager initiates a reconsideration of a determination previously made.

Determinations that can be reconsidered

Only determinations made under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act) can be reconsidered.

This includes determinations:

  • to accept or deny your claim for compensation
  • to stop payment of compensation
  • to increase or decrease your weekly payment of compensation
  • made by your employer in relation to your rehabilitation.

When you request a reconsideration, you can ask the review officer to consider certain documents on your claim file or provide new information relevant to your claim.

Determinations that cannot be reconsidered

A reconsideration cannot be requested following an:

  • announcement of an intention to make a determination—this is an opportunity for you to respond to the intention or provide additional supporting evidence
  • administrative decision including the deemed date of injury or illness and the label of an accepted condition.

If you are not sure whether you can request a reconsideration, you should contact your claims manager.

Requesting a reconsideration

You have 30 days from when you receive the determination to make a request for reconsideration or you need to apply for an extension.

Who can make a request

A reconsideration request can come from:

  • you or your representative
  • your employer.

A medical practitioner, allied health professional or health provider cannot request a reconsideration for you unless you have given your written consent for them to act on your behalf.

If you need more time to submit a request

If you need more time to submit your request for reconsideration, you should contact your claims manager.

To consider your request for an extension of time, you need to explain why you are unable to submit your request or evidence within the 30-day timeframe.

You may also be asked to provide evidence in support of your extension of time request.

Your claims manager needs to know:

  • what information you intend to provide
  • when you will provide it by
  • the purpose of the information.

Your request for an extension of time will be considered and you are advised of the reasons your request will be or will not be accepted.

An extension of time decision cannot be reconsidered.

How to submit your request for reconsideration

Employees of an Australian Government agency or statutory authority

We recommend you submit a request for reconsideration in writing, so there is no confusion although you can choose to make the request verbally.

  1. Submit a request for reconsideration in writing by completing the Reconsideration Request form (PDF, 112.8 KB).
  2. For your request for reconsideration to be accepted, you must include:
  • the date of the determination
  • the reason why you do not agree with the determination.
  • an additional statement or new evidence you would like to be considered—there is limited opportunity to submit new evidence once your request is received.

You do not need to provide copies of documents contained on your claim file as the review officer has access to those documents.

  1. Submit the form by:

Emailing the form to us prevents delays in receiving your request.

Your employer, or ex-employer, receives a copy of your reconsideration request and any additional information you provide. They are invited to respond to any new evidence or provide comments regarding your request.

Your employer also has the right to request a reconsideration of a claim decision. If this happens, we notify you and provide you with a copy of their request and any supporting information. In these circumstances you will be invited to respond.

Employees of a self-insured licensee

If you work for an organisation which is a self-insured licensee, a staff member in your organisation or a third-party provider manages the request for reconsideration. Speak with your human resources team for more information.

See a list of corporations and organisations with a self-insurance licence.

Reconsideration of own motion

A claims manager can make a reconsideration of own motion where the original determination contains an error of fact or law:

  • An error of fact occurs when relevant evidence has not been considered or evidence is received after the determination has been made which makes the determination unsustainable
  • An error of law occurs when a determination was inconsistent with the legislation or case law.

The claims manager should consider how a reconsideration of own motion on a past determination, which was made in good faith and based on relevant policy at the time, may adversely affect your rights, interests or legitimate expectations when deciding whether to undertake a reconsideration of own motion.

After we receive your request

The determination is reconsidered and you are issued with a reviewable decision in writing.

Reconsideration outcomes are known as a ’reviewable decision’. A reviewable decision will:

  • affirm – the determination does not change
  • vary – the determination is changed in some way, or
  • revoke – the determination is overturned and replaced with the reviewable decision.

Role of the review officer

Your review officer reviews all relevant documents on the claim file and any additional information provided during the reconsideration process.

The review officer is the best person to provide advice on the expected timeframe for reconsidering the determination

If the reconsideration is unable to be undertaken in the time initially advised to you, the review officer will contact you to advise of the delay, including the reasons for it.

If you disagree with the reviewable decision

If you disagree with the reviewable decision, you may apply to the Administrative Appeals Tribunal (AAT) to review the decision.

Your employer can also apply to the AAT for a merits review of the reviewable decision.

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 are included in the reviewable decision.

You can also request in-house facilitation, which is an alternate dispute resolution method that may allow you to resolve a claims-related dispute.

Page last reviewed: 10 December 2019
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Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 11 Jul 2020

https://www.comcare.gov.au/claims/disagree-determination/reconsideration