If you disagree with a claim determination
You can request a reconsideration of a primary decision made under the Seafarers Rehabilitation and Compensation Act 1992 (Seafarers Act).
Reconsiderations explained
If you disagree with your employer’s decision regarding your claim, you can request that the decision be reconsidered.
Also, if you do not receive a decision from your employer, or do not hear from your employer, within the time limits, your claim is taken to have been rejected. At this time, you are also entitled to request a reconsideration.
A reconsideration is not a court process. It is another look at the information and evidence on the claim to ensure the correct decision was made. The review officer can consider whether all relevant information was obtained and request additional information if necessary.
You can also request an alternate dispute resolution method that may allow a claims-related dispute to be resolved.
An employer may reconsider their own determination at any time, regardless of whether a reconsideration request is lodged by the employee.
What decisions can be reconsidered
Decisions that can be reconsidered
Only decisions made under the Seafarers Act can be reconsidered.
This includes decisions:
- 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.
Generally speaking, there is the same right of review for decisions regarding supports and entitlements as there is for the initial determination of liability when making a claim for workers’ compensation.
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.
Decisions that cannot be reconsidered
A reconsideration cannot be requested following an:
- announcement of an intention to make a decision—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.
Request a reconsideration
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.
How to submit a request for reconsideration
A request for reconsideration must:
- be in writing
- be provided to your employer within 30 days from the day you receive your employer’s decision on your claim
- set out the reasons for your request.
You do not need to provide copies of documents contained on your claim file as the review officer has access to those documents.
If you need more time to submit a request
If you need more time to submit your request for reconsideration, you should contact your employer. Your employer may give you an extension on the 30 days.
To consider your request for an extension of time, you usually 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 request for an extension of time will be considered by the person responsible for the reconsideration and you are advised of the reasons your request will be or will not be accepted.
An extension of time decision cannot be reconsidered.
Reconsideration process by your employer
Timeline
If you request a reconsideration of a determination, your employer has 60 days from receipt of your request to reconsider your claim.
An employer may request an extension of this deadline from the Seacare Authority.
Process for review
The person who made the first decision should not be the person making the reconsideration. This ensures a fresh perspective and procedural fairness in reconsidering the claim.
As part of the reconsideration, your employer must arrange for a Comcare officer or an Industry Panel to assist them with their reconsideration decision (at present, no Industry Panels operate in the Seacare jurisdiction).
Your employer may request additional information regarding the injury. If you refuse to provide this information without reasonable reason, your employer may refuse to progress the reconsideration further.
You may also submit additional information that may assist with the reconsideration of the claim. Any additional information provided should be forwarded to the reviewing Comcare officer and your employer.
Once the review is complete, the Comcare officer provides a report of the recommendations to both the employer and employee.
Notification of decision
Once the reconsideration is complete, your employer is required to provide you with a
- written notice affirming, revoking or varying the initial determination. The notice should set out the terms of the decision and the reasons for the decision
- brief statement outlining your rights to lodge an appeal with the Administrative Appeals Tribunal (AAT).
If you disagree with the reviewable decision
The determination made at the reconsideration stage is referred to as the reviewable decision because it becomes reviewable by the Administrative Appeals Tribunal (AAT).
If you disagree with reviewable decision, you can apply to have the decision reviewed by the AAT.
Appeals 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.
The AAT provides an independent review of your employer’s reconsideration decision based on all the facts and evidence and will provide a legally binding and enforceable decision. A review by the AAT involves a number of steps to resolve your dispute. This can include pre-hearing conferences, conciliation and where necessary a hearing.
Your employer can also apply to the AAT for a merits review of the reviewable decision.
Requesting alternate dispute resolution
You can choose to request an alternate means of dispute resolution that may allow you to resolve a claims-related dispute.
Where an employee disagrees with a determination or reviewable decision, employers may also consider inviting the relevant parties to engage in a conversation that encourages parties to reach a negotiated agreement. Such an approach can help to resolve disputes without needing to progress the matter through a formal review process.
Other benefits of this approach are:
- the process allows for disputes to be resolved in a timelier manner than through the AAT
- there is no cost to the employee or the employer, other than allowing the relevant parties to take part in the conversation during working hours
- the process allows for employees to be better informed and educated on the provisions of the Seafarers Act and to agree or disagree with any offers of settlements proposed
- the process allows claimants to actively engage in a productive dialogue regarding an ongoing claim
- it provides the employer with an opportunity to offer alternatives and different perspectives and to explain their position, limitations, liability and responsibilities
- it allows for an employer to establish or repair rapport and relationships with employees.
It is important to note that participation in alternate dispute resolution process does not negate your rights to initiate the formal processes of requesting a reconsideration or appeal should you wish or where an agreement is not reached.