For Queensland employers, receiving an unexpected workers’ compensation decision can be both operationally and financially significant. Whether the issue relates to claim acceptance, liability, or degree of impairment, it is important to understand that not all decisions made by WorkCover Queensland, or a self-insurer may be final. There are structured pathways available to have decisions reviewed and, if necessary, appealed. 

Understanding the initial decision on a workers’ compensation claim and how to trigger a review

A decision on a workers’ compensation claim may relate to matters such as: 

• Acceptance or rejection of a claim 
• Extent of injury or employment connection
• Liability for medical expenses or weekly benefits
• Assessment of permanent impairment

When an employer receives a decision, they can ask the insurer for written reasons for the decision (often called a statement of reasons) within 20 business days of being advised of the outcome. If you’re considering seeking a review of a decision, it’s important to know why that decision was reached and what was involved. 

In practice, it is best to make the request for a statement of reasons in writing and keep a clear record of when the decision was received, what documents were requested, and when the request was sent.

Once the reasons are provided, employers can review them carefully to identify the insurer’s key findings of fact, the evidence relied on, and the legislative tests applied. Important factors for considering a review include whether any relevant material was not considered, whether there are factual inaccuracies or inconsistencies, and whether the reasoning explains why any competing evidence was preferred.

This analysis will help to decide whether a review is warranted and, if so, what additional evidence or submissions will be needed to address the issues raised. 

Key steps employers can take in the review process

Step one: Internal review by the Regulator 

To launch a review of a workers’ compensation decision, a written application must first be made to the Workers’ Compensation Regulator, an independent body separate from insurers such as WorkCover Queensland, outlining reasons for the review. 

A review can be sought where the employer believes the decision is incorrect based on: 

• Incorrect application of legislation 
• Incomplete or inaccurate facts 
• Failure to consider relevant evidence 

Employers must lodge the application for review within 3 months of receiving the written decision. 

The employer should attach supporting documentation, such as medical evidence, investigation findings, or witness statements and the Regulator may request further information from either party. 

The Regulator generally aims to issue a decision within 25 business days of receiving all relevant information. The employer will be informed if the decision has been confirmed, varied, or set aside and replaced. 

Step two: Appeal to the Queensland Industrial Relations Commission (QIRC) 

If the employer disagrees with the outcome of the review, the next step is an appeal to the Queensland Industrial Relations Commission. 

An appeal must be lodged within 20 business days of receiving the review decision.

The QIRC will conduct a merits review, meaning it can reconsider the facts and evidence. This proceeding is more formal than the Regulator review process and legal representation is common, but not mandatory. 

Employers wanting an appeal of the decision need to file a notice of appeal with supporting submissions, provide all relevant evidence, and participate in directions hearings and a formal hearing, if required. 

The QIRC may: 

• Confirm the decision 
• Vary the decision 
• Set aside the decision and substitute a new one 

Further appeal options 

In limited circumstances, a party may appeal a QIRC decision to the Industrial Court of Queensland, but only on a question of law rather than factual dispute. This is a more complex and technical process, typically requiring legal advice and representation. 

Practical considerations for employers 

If an employer is eager to have a workers’ compensation decision reviewed, it’s important to consider the following:

Act promptly: Strict timeframes apply at each stage. Missing a deadline can result in losing the right to challenge the decision. 

Gather strong evidence: The strength of an application or appeal will depend heavily on evidence. This may include: 

• Independent medical opinions 
• Workplace incident reports 
• CCTV or other factual material 
• Witness statements 

Maintain procedural fairness: Ensure that any internal investigation or employer response aligns with procedural fairness principles. This strengthens credibility during the review process. 

Consider cost and strategy: Not all decisions warrant escalation. Employers should weigh: 

• Financial impact of the claim 
• Likelihood of success 
• Legal and administrative costs 

Seek advice where appropriate: Complex claims, particularly those involving psychological injuries or contested liability, may benefit from specialist advice. The workplace relations team at Business Chamber Queensland have a Workers Compensation Information and Advisory Service for Employers and can assist in the review or appeal process.