Ch 46 Reconsideration and Review

Sections 38, 60, 62 and 63 relate to matters concerning employees' rights to seek a review of certain determinations made by delegates and obligations on the MRCC in relation to the review.

If any part of a claim is 'rejected', a letter will be sent to the claimant (or to his/her representative if applicable) advising the reasons for that determination, any terms of the determination and a statement informing the claimant if they are dissatisfied with the determination they may request a reconsideration .

If the claimant disagrees with the decision, he/she may request reconsideration if:

• he/she is not satisfied with the reasons given to reject the claim, or
• he/she has more evidence to support the claim.

Claimants may ask for a reconsideration of a decision that relates to their claim. This includes, but is not limited to, initial determination of liability, determination of entitlement to weekly incapacity for work benefits, permanent impairment compensation payments, payment of medical expenses, payment for the cost of modifications to a home, car or workplace, payment for household and attendant care services and the provision of rehabilitation services.

The dependants of a deceased member may also ask for decisions relating to their claims to be reconsidered.

A request for reconsideration must be made in writing and must be lodged with the MRCC no more than 30 days after receipt of advice of the decision the claimant wishes to have reconsidered. In practice, the 30 day requirement is not strictly enforced but that is not to say there is an open ended time period for the lodgement of such requests. Any request for reconsideration must state why it is thought the decision is incorrect. If claimants have any more information or evidence to support the claim, it should be included with any request for reconsideration.

If a claimant is seeking new supporting evidence for the claim but has not obtained it by the end of the 30 day period, they should be encouraged to still send in the request for reconsideration. In the request, claimants should advise the MRCC of the evidence that is being sought and when they think they will be able to provide it.

An MRCC officer who was not involved in making the original decision will undertake the reconsideration of the decision. This is to ensure that claimants receive a fair and impartial re-assessment of their claim.

When the reconsideration is complete, the claimant (or his/her representative) is to be provided with written advice of the outcome of the reconsideration and the reasons for it.

If still not satisfied with the outcome after the claim has been reconsidered, a claimant can apply to the Administrative Review Tribunal (ART) for review of the reconsideration decision. The letter notifying the outcome of the request for reconsideration will include details of the claimant's right of appeal to the ART.

An application to the ART cannot be made unless:

• claimants have already lodged a request for reconsideration with the MRCC, and
• they have been advised in writing of the outcome of the reconsideration.

Applications for review by the ART must be lodged within 60 days of receiving written advice from MRCC regarding the outcome of the request for reconsideration.

More information regarding this topic is included in the Reconsiderations and Appeals handbook.