Workers Comp Claim Rejected? How to Ask for a Review (New South Wales, Victoria, Queensland and Every State)

You hurt your back lifting at work, saw the doctor, got a certificate of capacity, lodged the claim. Six weeks later the insurer’s letter says liability is declined: the injury is “degenerative”, or “not consistent with the mechanism described”, or you “did not report within the required time”. You’ve had no pay since. A no-win-no-fee firm looked at the file and said the claim was too small.

Decline letters are written to end the matter. In every state there’s a formal path to challenge them, and the first step is a document, not a lawyer. Insurers reverse a substantial share of decisions once a properly framed dispute arrives with the medical evidence attached, because the alternative is an independent body looking at the same file.

Your rights

Every workers compensation scheme in Australia gives an injured worker the right to dispute a decision that rejects liability, stops or reduces weekly payments, refuses medical treatment, or assesses work capacity. The general test is whether your employment was a significant (or, in some states, substantial or the main) contributing factor to the injury, or to the aggravation of a pre-existing condition. Aggravation of a degenerative condition is compensable if work contributed. Late reporting is usually excused where the employer knew, or where there’s a reasonable explanation. The insurer must give written reasons, and you are entitled to the documents it relied on, including any independent medical examination report.

By state

• New South Wales. Workers Compensation Act 1987 and Workplace Injury Management and Workers Compensation Act 1998. Ask the insurer in writing to review its decision, then apply to the Personal Injury Commission to determine the dispute. The Independent Review Office (IRO) funds a lawyer for you at no cost through ILARS and handles complaints about insurer conduct. Work capacity decisions have their own pathway (see our companion post).
• Victoria. Workplace Injury Rehabilitation and Compensation Act 2013. Apply for conciliation at the Workplace Injury Commission within 60 days of the decision (later applications need an explanation). If unresolved, medical questions go to a Medical Panel and liability disputes to the Magistrates’ or County Court. WorkSafe Victoria takes complaints about agent conduct.
• Queensland. Workers’ Compensation and Rehabilitation Act 2003. Apply to the Workers’ Compensation Regulator (Office of Industrial Relations) for review within 3 months of receiving the decision. If the review goes against you, appeal to the Queensland Industrial Relations Commission within 20 business days.
• Western Australia. Workers Compensation and Injury Management Act 2023 (from 1 July 2024). Lodge an application for conciliation with WorkCover WA’s Conciliation and Arbitration Services; if conciliation doesn’t resolve it, apply for arbitration (within 28 days if a certificate is issued that the dispute is unsuitable for conciliation).
• South Australia. Return to Work Act 2014. Apply to the South Australian Employment Tribunal for review within one month of the decision (the Tribunal can extend); you can also ask ReturnToWorkSA or the self-insurer to reconsider. SAET runs compulsory conciliation first.
• Tasmania. Workers Rehabilitation and Compensation Act 1988. Disputes are referred to the Workers Rehabilitation and Compensation Tribunal (now within TASCAT), which conciliates first and then hears the matter. WorkSafe Tasmania oversees insurers.
• Australian Capital Territory. Workers Compensation Act 1951. Compulsory conciliation first (arranged through the insurer under the Act and Regulation), then arbitration in the Australian Capital Territory Magistrates Court. WorkSafe ACT takes complaints about insurer conduct.
• Northern Territory. Return to Work Act 1986. Apply for mediation through NT WorkSafe, then, if unresolved, the Work Health Court.

Commonwealth and Australian Capital Territory public-sector employees under Comcare: request reconsideration under the Safety, Rehabilitation and Compensation Act 1988 within 30 days, then the Administrative Review Tribunal. The Claim Done document asks your state first and drafts the dispute notice to that state’s Act, review body and time limit.

What to do right now

1. Diarise the deadline from the date on the decision letter. Queensland’s 3 months and South Australia’s one month are hard; Victoria’s 60 days is strongly preferred. Lodge even if your evidence isn’t complete; you can add to it.
2. Request the full claim file in writing. The insurer’s reasons, the IME report, the employer’s incident report, any surveillance. You’re entitled to it, and the dispute must answer what’s actually in it.
3. Get your treating doctor to address the insurer’s reason. If the reason is “degenerative”, a letter explaining that work aggravated the condition is the single most important document. If it’s “mechanism inconsistent”, a letter on the mechanism.
4. Build the chronology. Date of injury or first symptoms, who you told and when, first medical visit, certificates, what duties you’ve done since. Late-reporting defences usually fall over on this.
5. Lodge the dispute with the body, and put the insurer on notice in writing. Many insurers reverse at this point rather than defend the file.

The four decline reasons and what beats them

“Pre-existing / degenerative.” Aggravation is compensable; the question is contribution, not cause. “Not reported in time.” Show the employer knew (a text to a supervisor counts) or explain the delay; most Acts excuse it. “Mechanism inconsistent.” Your account plus a treating doctor’s view usually outweighs an IME who saw you for 20 minutes. “No incapacity.” Certificates of capacity from your GP, and the actual duties on offer, decide this. Answer the stated reason directly; a dispute that argues general unfairness gets nowhere.

Who to complain to

For the decision itself: the review body for your state (above). For insurer conduct and delay: the IRO (New South Wales), WorkSafe Victoria, the Workers’ Compensation Regulator (Queensland), WorkCover WA, ReturnToWorkSA, WorkSafe Tasmania, WorkSafe ACT, NT WorkSafe. Your union, if you have one, will often run the dispute for you.

Put the decision in dispute before the deadline — $49

Claim Done drafts a Workers Compensation Claim Dispute for your state that answers the insurer’s stated reason point by point, sets out the medical chronology and the employment nexus, cites the Act and the review body and time limit, and requests the full claim file, ready to send to the insurer and lodge with the review body.

Dispute My Rejected Claim — $49 →

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