WorkCover claim rejected? How to apply for a review in Queensland (2026)
If your WorkCover claim is rejected in Queensland, you can apply to the Workers’ Compensation Regulator for an independent review. You must apply within 3 months after receiving the written decision and reasons. If you disagree with the result, you can generally appeal to the Queensland Industrial Relations Commission (QIRC) within 20 business days.
Key takeaways
Why a WorkCover claim might be rejected
An insurer may reject a WorkCover claim if it doesn’t meet the tests in the Workers’ Compensation and Rehabilitation Act 2003 (WCRA). For example, you must be a “worker” (s 11). The injury must also fit the definition in s 32, and you must lodge on time under s 131. Our WorkCover claims guide gives an overview of these rules.
Some claim types have extra exclusions. A mental injury caused by reasonable management action taken in a reasonable way is not an injury under the Act. Likewise, s 36 excludes some journey injuries. Our guides to psychological injury claims and journey claims explain both. Either way, the decision letter should tell you which test the insurer applied.
Step 1: Read why your WorkCover claim was rejected
The law gives you a right to reasons. Under s 134(4), an insurer that rejects a WorkCover claim must give you written reasons. It must also give you the information set by regulation. In addition, s 540(4) says the reasons must come with information about your review rights.
Before the rejection, the insurer must also run an internal check. Under s 538, a person more senior than the original decision-maker must review a proposed decision to reject a claim. So by the time you get a rejection letter, that internal review has already happened.
If the letter didn’t include reasons, act quickly. Under s 542(4), you must ask the insurer for reasons within 20 business days after you receive the notice. The insurer then has 5 business days to give them. After that, your 3 months to apply for review runs from the day you receive the reasons.
Step 2: Apply for a review by the Workers’ Compensation Regulator
If your WorkCover claim is rejected, the next step is an independent review. Under s 540(5), only the Workers’ Compensation Regulator can review these decisions. Under s 541, any claimant, worker or employer aggrieved by the decision may apply.
The application has some formal requirements. Under s 542(5), it must:
Which decisions the Regulator can review
Not every insurer decision goes to the Regulator. Section s 540 lists the reviewable decisions. For workers, the main ones include decisions to:
Time limits for a review when your WorkCover claim is rejected
The review deadline is short, so it is worth diarising. Under s 542(1), you must apply within 3 months after you receive the written decision and its reasons.
There is one safety valve. Under s 542(2)–(3), you may ask the Regulator for more time, but only once. The Regulator may grant it only if it accepts that special circumstances exist. Because the bar is high, people usually plan to apply within the 3 months.
WorkSafe Queensland explains how to lodge an application with the Regulator, including the current form.
|
Step |
Time limit |
Section |
|---|---|---|
|
Insurer decides your claim |
Within 20 business days after you apply |
s 134(2) |
|
Ask for reasons, if none were given |
Within 20 business days after you receive the notice |
s 542(4) |
|
Apply for review |
Within 3 months after you receive the decision and reasons (one extension request allowed) |
s 542(1)–(3) |
|
Regulator decides the review |
Within 25 business days after it receives the application, unless extended |
s 545(1), (4) |
|
Regulator sends its decision |
Within 10 business days after deciding |
s 546(1) |
|
Appeal to the QIRC |
Within 20 business days after you receive the review decision |
s 550(1)(a) |
How the Regulator decides
Under s 545, the Regulator must review the decision within 25 business days after receiving your application. It can extend that time in some cases. For example, it may do so with your consent, or if you ask in writing for time to give more information.
The Regulator then has four options. It can confirm the decision, vary it, or set it aside and substitute a new decision. Alternatively, it can set the decision aside and send the matter back to the insurer with directions. However, it can only do this in limited cases, such as when it has new information.
Next, the Regulator must give you written notice within 10 business days of deciding (s 546). The notice must state the reasons and your appeal rights. However, you can’t appeal a decision to send the matter back to the insurer. If the Regulator doesn’t decide in time, you can appeal to an industrial magistrate.
Appealing the review decision on a rejected WorkCover claim
If you disagree with the review decision, you can generally appeal. Under s 548A, most review decisions go on appeal to the industrial commission. That is the Queensland Industrial Relations Commission (QIRC). For some other decisions, the appeal body is an industrial magistrate instead.
The appeal deadline is tight. Under s 550, you must file a notice of appeal within 20 business days of receiving the review decision. You may ask for further time to appeal. You must also serve a copy of the notice on the Regulator within 10 business days after filing. The QIRC publishes the notice of appeal form and an appeal guide.
Finally, a party unhappy with the QIRC’s or magistrate’s decision may appeal to the Industrial Court under s 561. That court’s decision is final.
Getting help with a review of a rejected WorkCover claim
You can apply for a review yourself. Even so, some people get advice from a Queensland lawyer or another adviser, especially when the medical evidence is in dispute. If you are comparing firms, our comparison pages and methodology explain what we look at. Our guide on how to lodge a WorkCover claim covers the earlier steps.
Frequently asked questions
Sources
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About the author
Marshall Fenech, Editor
Marshall Fenech is the editor of Compare Personal Injury Lawyer QLD. He researches Queensland personal injury law firms and claim rules, checks every fact against public sources such as the Queensland Law Society, MAIC, WorkCover Queensland and Queensland legislation, and dates each check. He does not give legal advice.
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