The majority of workers’ compensation claims progress to the satisfaction of all parties involved, including the injured worker.
A dispute arises when an injured workers' compensation claimant does not agree with the decision of an insurer or self-insurer.
The processes available to resolve disputes include:
- Direct discussions and negotiations between the claimant and the representatives of the insurer or self-insurer.
- Use of the insurers or self-insurers Internal Dispute Resolution Process.
- The mediation service available through NT WorkSafe.
- The Work Health Court has the power to hear and determine all matters and disputes that arise in relation to the Return to Work Act 1986.
- A party aggrieved by a decision or determination of the Work Health Court may appeal against the decision or determination on a question of law to the Supreme Court.
Direct discussions and negotiations
While there are many ways to resolve conflicts, most problems can be resolved through simple discussion and common sense between the parties involved. In virtually all instances, you should at first attempt to resolve a dispute through direct discussion and negotiation.
Internal Dispute Resolution Process (IDRP)
The Northern Territory Workers' Compensation Best Practice Guidelines require that approved insurers and self-insurers should have an internal process for resolving a dispute between the injured worker and the approved insurer or self-insurer, or its representatives. This process should be readily accessible by injured workers without any charges imposed by the insurer or self-insurer. The internal process should provide a fair and timely method of handling disputes.
For the purpose of the IDRP, a dispute will have the same meaning as given in section 103B of the 'Return to Work Act'.
A dispute arises where a claimant is aggrieved by the decision of an employer:
- to dispute liability for compensation claimed
- to cancel or reduce compensation being paid
- relating to any matter or question incidental to or arising out of the claim for compensation.
A worker is aggrieved when they express dissatisfaction or disagreement with the insurer’s decision. The worker may have a belief that they have been treated unfairly or unjustly and may express dissatisfaction in those terms.
From the time of receiving a request for review, insurers or self-insurers should complete the IDRP in a maximum of five working days.
The process will involve the insurer or self-insurer arranging for an internal review by a senior review officer. This officer will not have made the original decision.
The process the senior review officer will follow is:
- review the decision
- review the material relied upon to make the decision
- consider any other material already on the claim file, and
- contact the worker and the employer and request any further material that may be relevant.
Following this review, the senior review officer will:
- maintain the original decision
- have the decision withdrawn, or
- vary the decision.
The senior review officer should, in every case, inform the worker of the decision in writing. However to speed up the process, the senior review officer should, where possible, convey the decision by phone or email, in addition to the letter being sent.
If the decision by the insurer or self-insurer is to maintain or vary the original decision it should be explained to the worker that if they remain dissatisfied with the decision from the review process, that they should apply to NT WorkSafe for mediation.
Mediation may help resolve disputes by sharing information and documents, identifying the issues in dispute, discussing them and trying to reach a mutually acceptable agreement. It is a fair, informal, quick service and is offered at no cost to the injured worker.
NT WorkSafe has a legislative role in dispute resolution by providing a mediation service. This service is provided by experienced independent mediators who are not employees of NT WorkSafe. Undertaking mediation is mandatory before any matter can be taken to the Work Health Court.
If the dispute is in relation to claim rejection, reduction or cancellation of benefits, a worker has 90 days from receipt of the insurer’s Notice of Decision and Rights of Appeal to apply to NT WorkSafe for mediation. Workers are encouraged to lodge a request with NT WorkSafe for mediation as soon as possible after the dispute arises.
An application for mediation must be in writing and may be emailed, posted, hand-delivered, or faxed to NT WorkSafe. You can either use the 'notice of decision' and 'rights of appeal form' provided by the insurer or the 'application for mediation form'.
The worker may contact the Workers' Rehabilitation and Compensation section in NT WorkSafe on 1800 250 713 for assistance with their application.
A mediator will be appointed within seven days of NT WorkSafe receiving your written request for mediation.
View further information on the mediation process.
Work Health Court
If a party to a dispute is dissatisfied with the outcome of the mediation process they may then make an application to the Work Health Court.
An application to the Work Health Court should be made within 28 days of the party receiving a Certificate of Mediation, although the Court has the power to extend the 28 day time limit.
The Work Health Court is constituted by a magistrate or, in certain circumstances, the Registrar or Judicial Registrar. The Court has the power to hear and determine claims for compensation and all matters incidental to or arising out of such claims.
Before hearing a matter, the Court must hold a directions conference. At this conference the Court can award interim benefits and may adjourn to a conciliation conference. If the matter is not resolved at the conference stage, the matter will be resolved at a hearing before a magistrate.
A decision of the Work Health Court can be appealed to the Supreme Court but only on matters of law and only after the matter has been finally determined by the Work Health Court.
The below videos has been developed to give helpful information about dispute resolution:
|Mediation process for workers compensation|
|Preparation for workers compensation mediation|
|Application for mediation|