Frequently asked Questions
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What sorts of complaints does the WorkCover Ombudsman investigate?
The WorkCover Ombudsman is able receive and investigate complaints about administrative acts under the Act, including issues associated with rehabilitation and return to work. The administrative acts you may seek to complain about may relate to the way services are offered or delivered in connection with the management of your claim or rehabilitation.
Some examples of complaints we have investigated are:
- communication problems with case managers;
- delays in reimbursing costs incurred by injured workers;
- rehabilitation and return to work plans not in place;
- imposition of levy penalties;
- injured workers not being provided with suitable employment;
- delays in receiving weekly payments; and
- documents not being released to injured workers.
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What is the WorkCover Ombudsman unable to investigate?
The WorkCover Ombudsman’s power to investigate is confined to complaints and issues that relate to the Workers Rehabilitation and Compensation Act 1986. In addition, the Office has no power to investigate complaints that concern matters that are:
- reviewable decisions under the Workers Rehabilitation and Compensation Act 1986
- the subject of legal proceedings
- an industrial dispute under the Fair Work Act 1994.
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Under what circumstances can the WorkCover Ombudsman refuse to receive or entertain a complaint?
Pursuant to section 99D(5) of the Act, the WorkCover Ombudsman may refuse to entertain a complaint, or, having commenced to consider a matter raised in a complaint, may refuse to continue if of the opinion-
- that the matter raised in the complaint is trivial; or
- that the complaint is frivolous or vexatious or is not made in good faith; or
- that the complainant or the person on whose behalf the complaint was made has not a sufficient personal interest in the matter raised in the complaint; or
- that the complainant has failed, without good reason, to take reasonable steps to resolve the matter through another established complaint handling process; or
- that having regard to all the circumstances of the case, the investigation or the continuance of the investigation of the matter raised in the complaint is unnecessary or unjustifiable; or
- that the matter raised in the complaint should be dealt with under another Act or by another person or body; or
- that there is some other reasonable cause that justifies the discontinuance of proceedings under this Part.
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Who can complain to the WorkCover Ombudsman?
The WorkCover Ombudsman is able to receive and investigate complaints from workers, employers and other interested parties. If a person is unable to speak for himself or herself, the WorkCover Ombudsman may ask the person affected to confirm in writing that they are happy for a representative to act for them in regard to their complaint.
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Can my lawyer lodge a complaint on my behalf?
Yes.
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How do I make a complaint?
You can make a complaint to the WorkCover Ombudsman in person, by phone, by fax, email or by lodging it online. You can find an online complaint form on this website. You can submit your complaint online or you can download, print off, fill in and send to us if you prefer.
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What information should I include in my complaint?
The following information should be included in your complaint:
- your name, address, telephone and fax numbers, and an email address if available;
- whether you are complaining on behalf of someone else;
- which agency, organisation or person are you making a complaint about;
- summarise the decision or conduct about which you wish to make a complaint;
- on what date did the decision or conduct occur;
- what action have you taken to try and resolve the matter;
- what result or outcome are you seeking; and
- attach relevant documentation you have.
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How much will it cost me to have a complaint investigated?
All services provided by the WorkCover Ombudsman are free of charge.
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How long will it take to investigate a complaint?
The time taken to investigate will vary depending on the particulars of each complaint. Factors that impact on the timeframe include the complexity of the issues raised in a complaint, the need to obtain information from the organisation or departmental staff involved, the need to provide procedural fairness and staff workloads. If there are urgent aspects to your complaint, you should bring this to the attention of the WorkCover Ombudsman as early as possible when you lodge your complaint.
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What does an investigation involve?
After assessing and determining that your complaint is a matter that the WorkCover Ombudsman has jurisdiction to investigate we then approach the agency or organisation with details of your complaint and invite it to respond to the concerns raised. Once the response has been received, the available information will be assessed, and the WorkCover Ombudsman will determine whether any further action is necessary. If the WorkCover Ombudsman is initially satisfied with the response, or if it is necessary to clarify information, you will be contacted for your views and comments.
When conducting an investigation the WorkCover Ombudsman may exercise powers in accordance with the Act. This may involve requesting an agency or organisation to provide written responses to the concerns raised, producing documents or requiring a person to provide information under oath.
At any stage of the investigation the WorkCover Ombudsman may decide to attempt to deal with a complaint by conciliation. The Ombudsman may act personally or through some other person.
Once all relevant information has been obtained, and all parties have had a proper opportunity to comment, the WorkCover Ombudsman will form a view about the actions complained about. If it is assessed that the agency or organisation has acted fairly, the WorkCover Ombudsman will express this view to you in writing and explain why. Alternatively, if it is considered that an error or unfairness has occurred then the WorkCover Ombudsman will attempt to negotiate a resolution between the parties.
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Will I be kept informed of your progress?
We will keep you informed of the progress of your complaint and explain to you the reasons for any decisions we make. You are also free to contact us at any time to ask questions or seek further information about your complaint.
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What does an investigation achieve?
If an investigation is conducted, the Workcover Ombudsman has the authority to make recommendations to the relevant parties but cannot compel an agency or organisation to change its decision and substitute his decision in its place.
If the Workcover Ombudsman finds that an administrative act is unreasonable he can refer the matter back to the relevant party for it to reconsider. However, that party may still choose to ignore this recommendation and persist with its original decision. Alternatively if it does reconsider its decision, the ultimate decision may be the same as the original decision.
Even so, the investigation provides an opportunity for you to obtain greater clarity and understanding about the decision or action taken by the agency or organisation.
If the WorkCover Ombudsman considers that the agency or organisation has acted in an unreasonable manner and it will not negotiate a suitable resolution or implement a recommendation, the WorkCover Ombudsman is able to report the matter to the relevant Chief Executive Officer, the Minister and detail the circumstances in the Annual Report, which is tabled in both houses of Parliament.
Even if you are not satisfied with the final outcome of your complaint the WorkCover Ombudsman keeps records of all complaints and sometimes identifies patterns which may point to a systemic problem in the way that an agency or organisation delivers its service. As one of our functions is to identify and review issues arising out of the operation or administration of the Act, your information will be useful for when recommendations are made for improving processes that affect both workers who have suffered a compensable disability or employers.
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Will you investigate a complaint if I have not complained to EML or the employer first?
We generally do not receive and investigate complaints if you have not attempted to resolve your complaint with the agency or organisation concerned. If you are dissatisfied with the way services are offered or delivered in connection with the management of your claim or rehabilitation you should first approach the agency concerned and genuinely try to resolve your problem. Most agencies and organisations have established complaints handling procedures but if they don't, speak with a person in authority and keep a record of your discussions.
We recommend that you write to the agency or organisation outlining your concerns and the outcome you are seeking. You should then allow a reasonable time for a response.
Make sure you tell them what you want to happen. For example, are you seeking to have the decision changed, the conduct of a person addressed or are you seeking an apology?
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Can the WorkCover Ombudsman provide me with legal advice about my worker’s compensation claim?
No. We cannot offer you legal advice or representation.
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Do you have interpreting services available to people who cannot speak or read English?
The Office also has an arrangement with the Interpreting and Translating Centre (ITC) so that an interpreter will be provided to you in your preferred language at no cost to you. Please contact the ITC on (08) 8226 1990 and ask the interpreter to contact the Office if you require an interpreter. Information about our office has been published in 24 different languages.
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What can I do if I am dissatisfied with the WorkCover Ombudsman’s decision or outcome?
Like most agencies and organisations, the WorkCover Ombudsman is focused towards continuously improving our services, so we will welcome any feedback, complaints or suggestions. Please see our Feedback & Complaints Policy.
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