Workplace Injury Commission Victoria

What types of complaints can you make?

You can go to WIC if you disagree with a decision made by your WorkSafe Agent or self-insurer about your workers compensation. WIC resolves disputes informally through conciliation and, in some cases, arbitration.

The main types of disputes WIC can handle are:

• Claim and eligibility disputes: for example, if your claim is rejected, delayed, or the insurer has not responded or paid within a reasonable time.
• Weekly payment disputes: for example, if your weekly payments are reduced or stopped before 130 weeks, stopped at the 130-week limit, calculated incorrectly, superannuation contributions are not paid, or interest is missing from late payments.
• Medical and related expense disputes: for example, if your insurer refuses to pay for treatment, rehabilitation, counselling, surgery, physiotherapy, travel costs, or equipment you need for recovery.
• Permanent impairment benefit disputes: for example, if there is disagreement about your entitlement to a lump sum for a permanent disability or the insurer delays your impairment assessment.
• Return-to-work disputes: for example, if your employer does not meet their obligations to offer suitable duties, plan your return to work, or stay in contact. WIC can also help if you are accused of not cooperating with return-to-work activities and your payments are suspended.
• Other disputes: for example, if the insurer refuses to give you important claim information, does not provide provisional payments for a mental injury claim, or if dependants dispute benefits after a worker has died due to a work-related injury.

Jurisdiction:

WIC can assist with conciliations and arbitrations in Victoria.

Conciliation:

• Apply in writing using the Application for Conciliation form.
• Lodge within 60 days of the insurer’s decision (late applications may be allowed with reasons).

Arbitration:

• Only available if you first go through conciliation and receive a Genuine Dispute Certificate.
• Available for injuries from 1 September 2022 onwards.
• Injuries between 1 September 2022 and 30 March 2024 – WIC can arbitrate weekly payments, medical expenses, superannuation, late payment interest, PIAWE, work capacity, and liability disputes.
• Injuries on or after 31 March 2024 – WIC can arbitrate weekly payments, medical expenses, superannuation, late payment interest, PIAWE, and ability to work after 130 weeks (liability disputes excluded).
• Referral for Arbitration form must be lodged within 60 days (late applications may be accepted in special cases).

WIC cannot handle:

• Common law claims (suing for negligence).
• Complaints about bullying, harassment, or discrimination.
• Disputes about WorkSafe inspector decisions or enforcement notices.
• Complaints about insurer or agent behaviour (e.g. rudeness or bias).
• WorkSafe’s return-to-work directions.
• Private insurance disputes (e.g. income protection, TPD).
• Complaints about the outcome of WIC conciliation (next step is arbitration or court).
• HR issues like dismissal, redundancy, or rostering.
• Fraud or criminal allegations.
• Claims from other states or under Comcare (federal system).
• Injuries outside Victoria if the job was not mainly based in Victoria.
• Disputes with no insurer decision yet.
• Disputes already decided by court or binding arbitration.
• Applications lodged outside the 60-day limit (unless WIC grants permission).

Discretion:

WIC decides whether to accept a case. If they decline, you’ll receive written reasons.

Who can you make a complaint against?

WIC resolves disputes mainly between injured workers and the people or organisations responsible for managing workers compensation.

You can make a complaint against:

• Insurers (WorkSafe agents): insurance companies authorised by WorkSafe Victoria to manage workers compensation claims (for example, Allianz, EML, Gallagher Bassett).
• Self-insurers: large employers licensed to manage their own workers compensation claims, instead of using a WorkSafe agent (for example, Coles, Woolworths, Metro Trains).
• Employers (not self-insured): smaller employers whose claims are handled by a WorkSafe agent. They may be respondents in disputes about return-to-work duties or whether someone is a “worker” under the law.
• Labour hire and host employers: in labour hire situations, both the agency that employs you and the host business where you work may be involved, especially for return-to-work disputes.
• Return-to-Work Inspectors or WorkSafe Victoria (indirectly, rare): sometimes disputes relate to findings by a return-to-work inspector that affect your benefits, but WIC resolves the dispute about the outcome, not against WorkSafe itself.
• Other dependants: in death benefit disputes, different family members may be parties to the dispute (for example, a spouse and an adult child contesting benefits).

You cannot make a complaint against:

• WorkSafe Victoria as a regulator: you cannot use WIC to complain about WorkSafe’s conduct, investigations, inspectors, or licensing decisions.
• Lawyers, union representatives, or advocates: complaints about their behaviour must go to their professional bodies.
• Doctors or Independent Medical Examiners (IMEs): WIC does not investigate their conduct. Complaints go to WorkSafe or AHPRA.
• The Workplace Injury Commission itself: complaints about WIC services or decisions must go through their feedback process or the Victorian Ombudsman.
• Private insurers: WIC does not cover life insurance, income protection, or other private policies.
• Interstate employers or insurers: WIC only handles Victorian WorkCover claims.

Are you eligible to make a complaint?

Conciliation:

• You can go to conciliation if your WorkSafe Agent or self-insurer made a decision on your claim that you don’t agree with.
• You can also go if they have ignored your request or delayed a payment for too long.
• You need to send WIC an Application for Conciliation form within 60 days of the insurer’s decision.
• If you miss the deadline, WIC may still accept your application if you explain why it’s late.
• If your case was dismissed before, you can apply again with a Dismissal Certificate.

Arbitration:

• Arbitration is only available after you’ve tried conciliation and received a Genuine Dispute Certificate.
• You (the worker) can apply yourself, or someone can apply on your behalf if you give written permission on the Referral for Arbitration form.
• You must lodge the arbitration form within 60 days of receiving the Genuine Dispute Certificate (late lodgement may be accepted in some cases).
• You cannot take the same dispute to court while it’s with WIC.
• What WIC can arbitrate depends on when your injury happened (see Step 2: Jurisdiction).

Getting help:

• Conciliation is free. You don’t need a lawyer.
• You can bring a friend, family member, union rep, or support worker.
• Free help is available from Union Assist (www.unionassist.org.au) and WorkCover Assist (www.workcoverassist.vic.gov.au).
• If you want a lawyer at conciliation, the Conciliation Officer must approve it.
• Arbitration is also free. If you win, the insurer usually pays your legal costs. If you lose, you normally don’t pay their costs, but you’ll need to cover your own medical reports and legal fees.

When WIC cannot help:

• If you haven’t lodged a WorkCover claim yet.
• If you’re not the injured worker or their dependent (unless you have legal authority, such as power of attorney).
• If you’re not considered a “worker” under Victorian law (unless that definition itself is what’s being disputed).
• If your compensation is managed under another scheme, such as Comcare or another state.
• If your dispute is already in court or has already been decided.
• If you apply after the 60-day deadline without good reason.

What can this body do to help?

WIC can help injured workers and insurers resolve disputes in several ways.

Conciliation outcomes:

• Agreement between parties: the worker and insurer reach a resolution. This is the most common outcome and can cover payments, medical treatment, or return-to-work arrangements.
• Recommendation by Conciliation Officer: if no agreement is reached, the officer may suggest a solution. This is not binding but often helps guide settlement.
• Referral of medical questions to a Medical Panel: if the dispute is about medical facts (such as level of impairment or work capacity), the officer can refer it to a panel of doctors. The panel’s decision is final and binding.
• Direction to insurer to pay: if the insurer clearly owes compensation (such as weekly payments or medical expenses), the officer can order them to pay. This power is only used in limited situations.
• Dismissal of dispute: if the case is invalid, outside WIC’s powers, withdrawn, or has no merit, the officer can dismiss it. The worker may still apply for arbitration or go to court.
• Genuine Dispute Certificate: if conciliation fails, WIC can issue this certificate. It allows the worker to take the matter to arbitration (if eligible) or to court.

Arbitration outcomes:

• Binding decision: the arbitrator can overturn an insurer’s decision and order compensation, or confirm that the insurer’s decision was correct.
• Payments: the arbitrator can order up to 52 weeks of weekly payments and up to $20,000 for medical and related expenses.
• Adjustment of entitlements: the arbitrator can recalculate what the worker is owed.
• Further conciliation: the arbitrator can refer the case back to conciliation if settlement looks possible.
• Binding agreement: if the parties agree during arbitration, it can be recorded as a formal arbitral award, which is legally enforceable.
• Appeal to the Supreme Court: arbitration decisions are final, but either side can appeal to the Supreme Court on a question of law only (not just because they disagree with the outcome).

WIC is unable to provide:

• Compensation for pain and suffering: these claims must go through court as a common law claim.
• Punitive or exemplary damages: WIC cannot punish an insurer or employer.
• Compensation beyond limits: arbitration cannot award more than 52 weeks of weekly payments or $20,000 in medical expenses. Higher amounts must be pursued in court.
• Damages for inconvenience or stress: WIC cannot award money for poor treatment by an insurer.
• Findings about behaviour: WIC cannot make findings about bias, rudeness, or harassment by an insurer or employer.
• Employment orders: WIC cannot order reinstatement, promotions, or entitlements such as redundancy or long service leave.
• Remedies under other laws: WIC cannot provide remedies under discrimination, OHS, tax, superannuation, or privacy law.
• Injunctions or stop orders: WIC cannot order an insurer or employer to stop doing something (e.g. surveillance).
• Override Medical Panel decisions: once a Medical Panel makes a binding decision, WIC cannot change it.

How to prepare your complaint:

What to include:

• Personal details: full name, contact number, date of birth, email, and postal address.
• Respondent details: employer name and the WorkSafe Agent or self-insurer involved.
• Key facts: what your dispute is about, who is involved, what outcome you want, and reasons for late lodgement if over 60 days.
• Supporting documents for conciliation: insurer decision letter, request for treatment with no response, certificates of capacity if weekly payments stopped, invoices or receipts for unpaid medical treatment, medical reports, payslips, or other relevant evidence.
• Supporting documents for arbitration: copy of the Genuine Dispute Certificate, reasons if lodged after 60 days, details of any court proceedings, when your injury happened (to confirm arbitration is available), why you believe the insurer’s decision is wrong, and the outcome you want.

Important notes:

• Provide as much detail as possible, including correspondence with the insurer.
• Do not make false or misleading statements: this is an offence.
• When you apply, you will be asked to give permission for WIC to share your complaint details with the insurer: without this permission, WIC may not be able to act.

Lodging your complaint and next steps:

Where to lodge:

• Conciliation: complete the Application for Conciliation form and send by email (afc@wic.vic.gov.au), post (GPO Box 251, Melbourne 3001), or in person (Level 1, 215 Spring St, Melbourne).
• Arbitration: complete the Referral for Arbitration form and send by email (arbreferral@wic.vic.gov.au), post (GPO Box 251, Melbourne 3001), or in person (Level 1, 215 Spring St, Melbourne).
• If unsure or needing help: call WIC on 03 9940 1111 or 1800 635 960, or visit www.wic.vic.gov.au.
• Interpreter or translator support: available free of charge through TIS National (call 131 450).

After you lodge:

• Conciliation receipt: WIC will confirm your application. Due to high demand, there is currently a 3–5 month wait for conferences. WIC will check in with you and send a letter once your conference date is set.
• Arbitration receipt: WIC must hold an initial hearing within 30 days, any further hearings within 60 days, and make a final decision within 14 days after the last hearing.
• Pre-conference: WIC may ask you and the insurer for more information. This is shared between the parties, but not directly with your employer.
• Conciliation conference: a meeting with you, the insurer, and a Conciliation Officer where everyone can explain their views and try to reach agreement.
• Arbitration hearing: if conciliation fails, you may choose arbitration instead of court. Depending on the injury date, the Arbitration Officer can order the insurer to accept a claim, calculate compensation, pay up to 52 weeks of weekly payments and $20,000 in medical expenses, or confirm the insurer’s decision is correct.

Other important information:

• You cannot take the same dispute to court while it is with WIC for arbitration.
• More information about conciliation and arbitration is available at www.wic.vic.gov.au.

More information:

Refer to the factsheet provided below for more information.