Queensland Consolidated Acts

WORKERS' COMPENSATION AND REHABILITATION ACT 2003 - SECT 538

538 Internal review by insurer

(1) Before an insurer makes any of the following decisions, the insurer must undertake an internal review of the proposed decision—

(a) a decision to reject an application for compensation;

(aa) a decision not to provide a service under section 232AB ;

(b) a decision under section 232M that a worker is not entitled to treatment, care and support payments;

(c) a decision to refuse a service request, or approve a service request on conditions, under section 232P ;

(d) a decision to refuse a payment request under section 232R ;

(e) a decision under section 232S that the insurer is not satisfied that a worker’s serious personal injury is likely to continue to meet the chapter 4A eligibility criteria for the injury after the interim period ends;

(f) a decision under section 232S that a worker’s entitlement to treatment, care and support payments ends before the end of the interim period;

(g) a decision to not accept liability to make treatment, care and support payments under section 232ZD ;

(h) a decision to amend approved services for an eligible worker under section 232ZG ;

(i) a decision to suspend, under section 232ZH , a worker’s entitlement to treatment, care and support payments for all or part of a period the worker is absent from Australia;

(j) a decision to terminate compensation;

(k) a decision under section 325C to refuse an examination application.

(2) The review must be made by a person who is in a more senior position than the person who proposes to make the decision.