CONCILIATION _0715_WOR0583.indd 3 16/07/15 9:26 AM

Transcription

1 CONCILIATION

2 CONCILIATION WORKER S FREQUENTLY ASKED QUESTIONS Q: What happens at conciliation? A: An injured worker is able to appeal a decision made by CGU Workers Compensation (CGU) by lodging a request for conciliation through the Accident Compensation Conciliation Service (ACCS). CGU is then required to review the decision and present their reasons for making the decision at a conciliation conference. An independent Conciliation Ofcer conducts the conciliation conference Q: What is the role of a Conciliation Ofcer? A: Conciliation Ofcers are appointed by the Governor in Council in Victoria and are independent of all parties involved in a WorkCover dispute. The role of a Conciliation Ofcer is to facilitate discussion between the parties in the hope of reaching an agreement. If an agreement is reached between the parties, the Conciliation Ofcer issues an outcome certifcate detailing what has been agreed to.

3 Q: What if no agreement is reached? What are the possible outcomes of conciliation? A: Prior to the conciliation conference, CGU will conduct a thorough review of the fle and any new information available. If it is established upon review that CGU s decision is no longer supported, then a decision can be made by CGU to withdraw the decision prior to or at the conciliation conference. There are a number of other outcomes that may result from conciliation including: Recommendation or Agreement: CGU can agree to make payment of weekly compensation and/or medical and like expenses for a set period of time under a recommendation by the Conciliation Ofcer. Medical Panel referral: The Conciliation Ofcer may refer medical questions to a Medical Panel if they determine that a medical dispute exists. The opinion of the Medical Panel is binding, and an outcome certifcate is then issued refecting the opinion. Genuine Dispute certifcate: If an agreement cannot be reached or medical panel referral is not appropriate, then a certifcate of Genuine Dispute can be issued. Once the certifcate has been issued the worker may take the matter to court. Direction: A Conciliation Ofcer can make a decision to issue a direction for CGU and the employer to make payment if they do not believe that CGU has an arguable case. Q: What is an employer s role at conciliation? A: The employer s role at conciliation depends on the nature of the dispute. The employer may be required to confrm or verify details of your work or work situation. An employer s attendance at a conciliation conference is not compulsory but they are encouraged by CGU to attend in order to assist with resolving the dispute.

4 Q: Who will attend conciliation from CGU? A: CGU has a specialised Dispute Resolution Team that attends most conciliation matters. Some disputes may be allocated to a Case Manager or Technical Manager depending on the nature of the dispute and/or the availability of Dispute Resolution Ofcers. Certain disputes are handled by specialists in particular areas of the business (for example Pre-injury Average Weekly Earning disputes or Impairment Beneft claims). Q: Where can I get more information about conciliation? A: The ACCS will send out a letter advising all parties of the date, time and location of a conciliation conference. The ACCS also sends a DVD, which helps to explain the conciliation process. Workers can contact their Case Manager in relation to their queries about conciliation. In addition you can refer to or for further information about the conciliation process. Q: How can I request medical reports to support my request? A: CGU often requests medical information from your treating doctor prior to making a decision. Upon lodging a request for conciliation, the ACCS will request further medical information from relevant treating doctors or treatment providers. You may also request this information from your treaters to support your request for conciliation. CGU will pay for the reasonable cost of these reports as long as a copy of the report is provided to CGU. Q: Can I claim for the costs to attend conciliation? A: An injured worker can claim travel costs up to a maximum of $59 and loss of income up to $401 for attending a conciliation conference by completing a Conciliation Costs Declaration Form which is provided at conciliation (*Indexed annually) Refer to for further information about current rates.

5 POST CONCILIATION Q: If an agreement or recommendation is reached at conciliation, how long does an employer have to make payment? A: If an agreement is reached that requires the payment of either weekly compensation or medical and like expenses, CGU and the employer are required to make the relevant agreed payments upon receipt of the required information. Potential Delays To enable weekly compensation payments to be paid, CGU is required to seek clearance from Centrelink prior to payments being made. Once the clearance is received, the employer is required to make the payment (less any Centrelink deductions and tax). Please note that agreements that involve medical expenses require minimum invoicing and provider registration requirements to be met prior to any payment being made. CGU is unable to pay any medical or treatment costs that are over and above the VWA recommended fee for the service. CGU require valid certifcates of capacity from a registered provider to process weekly payments. Q: Who can I contact if an employer or CGU has not made payments in accordance with a conciliation outcome? A: If CGU or an employer has failed to make payments in accordance with the conciliation outcome, you should contact your Case Manager. CGU is committed to make the workers compensation experience a positive one for all customers. We value your feedback and welcome you to share your experiences with our Customer Feedback Team. Our Customer Feedback Team can be contacted on Free call number or us on wcvcustomerfeedback@cgu.com.au to assist you with any queries or feedback.

6 CONTACT DETAILS Enquiries Claims Mailing address GPO Box 9902 in your capital city Sydney 388 George Street Sydney NSW 2000 Melbourne 181 William Street Melbourne VIC 3000 Brisbane 189 Grey Street South Bank QLD 4101 Perth 46 Colin Street West Perth WA 6005 Adelaide 80 Flinders Street Adelaide SA 5000 CGU.COM.AU WOR0583 REV5 7/15 Insurance Australia Limited ABN trading as CGU Workers Compensation