The Work Capacity Decision
The Work Capacity Decision Review model makes available to injured workers a three-tiered process (see diagram below), for potential reviews of Work Capacity Decisions made by insurers:
- Internal review by the Insurer;
- Merit Review by the authority; and
- Procedural Review by WIRO
[caption id="attachment_1885" align="alignnone" width="500"]
Click on the image for a larger view.[/caption]The diagram below provides a greater degree of detail about what happens at each stage of the Work Capacity Decision Review process.
What’s the difference between the Work Capacity Review stages?
Each of the review stages have very different characteristics and so each needs to be approached and prepared for differently.
- Internal Review by the Insurer
- Stand in the shoes of the original decision maker (review not appeal)
- Make a fresh decision on the merits (de novo)
- Consider all available new relevant information (correct and preferable decision)
- Enables direct feedback to front line Insurer decision makers to improve decisions
- Merit review by the Authority
- Stand in the shoes of the original decision maker (review not appeal)
- Make a fresh decision on the merits (de novo)
- Consider all available new relevant information (correct and preferable decision)
- Procedural Review by WIRO
- Review the original process used by the original work capacity decision maker
- Determine if original work capacity decision was procedurally correct
- Not a review of the substantive merit issues or the Internal Review or Merit Review
Correct or preferable…
“The objective of merits review is to ensure administrative decisions are correct or preferable – that is, they are made according to law, or if there is a range of decisions that are correct in law, the best on the relevant facts. It is directed to ensuring fair treatment of all persons affected by a decision, and improving the quality and consistency of primary decision making.”
Administrative Review Council, What decisions should be subject to merits review? (1999)Quick Tip:#1 Know your audience… If you’re dealing with an application for a Merit Review, focus on the MERITS of the matter… the current facts, evidence, law, and issues in dispute, not on the Insurer’s processes or procedures, which are only relevant before WIRO.If you have been injured in a workplace accident and need to seek workers compensation contact our WIRO Lawyers today 1300 363 013
