Section 43 Subsection 1 must be noted that the decision of the Work Capacity Decision by an insurer is filed and binding on the parties and not subject to appeal or review except under Section 44BB or judicial review by the Supreme Court.
(See Extract Section 44BB)
Section 44BB Review of Work Capacity Decisions
- An injured worker may refer a Work Capacity Decision of an insurer for review:
- by the insurer in accordance with the Workers Compensation Guidelines within 30 days after an application for internal review is made by the worker, or
- by the Authority (as a Merit Review of the decision), but not until the dispute has been the subject of internal review by the insurer, or
- to the Independent Review Officer (as a review only of the insurer’s procedures in making the Work Capacity Decision and not of any judgment or discretion exercised by the insurer in making the decision), but not until the dispute has been the subject of internal review by the insurer and Merit Review by the Authority.
- An application for review of a Work Capacity Decision must be made in the form approved by the Authority and specify the grounds on which the review is sought. The worker must notify the insurer in a form approved by the Authority of an application made by the worker for review by the Authority or the Independent Review Officer.
- The insurer is to notify the worker of the decision on an internal review as soon as practicable after the review is conducted.
- The following provisions apply to the review of a Work Capacity Decision when the reviewer is the Authority or the Independent Review Officer:
- an application for review must be made within 30 days after the worker receives notice in the form approved by the Authority of the insurer’s decision on internal review of the decision (when the application is for review by the Authority) or the Authority’s decision on a review (when the application is for review by the Independent Review Officer),
- an application for review by the Authority may be made without an internal review by the insurer if the insurer has failed to conduct an internal review and notify the worker of the decision on the internal review within 30 days after the application for internal review is made,
- the reviewer may decline to review a decision because the application for review is frivolous or vexatious or because the worker has failed to provide information requested by the reviewer,
- the worker and the insurer must provide such information as the reviewer may reasonably require and request for the purposes of the review,
- the reviewer is to notify the insurer and the worker of the findings of the review and may make recommendations to the insurer based on those findings (giving reasons for any such recommendation),
- the Independent Review Officer must also notify the Authority of the findings of a review and the Authority may make recommendations (giving reasons for any such recommendations) to the insurer based on those findings,
- recommendations made by the Authority are binding on the insurer and must be given effect to by the insurer,
- recommendations made by the Independent Review Officer are binding on the insurer and the Authority.
- The Commission is not to make a decision in proceedings concerning a dispute about weekly payments of compensation payable to a worker while a Work Capacity Decision by an insurer about those weekly payments is stayed.