Workers Compensation Independent Review Service Exceptional Circumstances Policy

What are 'exceptional circumstances'?

Exceptional circumstances are circumstances which are out of the ordinary, unavoidable or unexpected.

Whether there are exceptional circumstances will depend on an injured Worker’s particular circumstances and include circumstances that:

• are outside of the Worker's control, and
• which the Worker could not reasonably have prevented or accommodated, and
• must have had a significant, demonstrated and negative effect on the Worker's ability to apply to WCIRS within the time limit

The WCIRS may contact the Worker or their representative to clarify or request further information about the reasons for any delay in applying for a review.

What is not an 'exceptional circumstance'?

The following are not exceptional circumstances:

• being unaware of the timeframe for lodging a WCIRS review
• the fact that the Worker has suffered an injury requiring treatment without medical evidence explaining why it significantly contributed to the Worker delaying their application for a WCIRS review

Factors that can constitute exceptional circumstances

Examples of what may constitute exceptional circumstances, with appropriate evidence and explanation, include but are not limited to:

• a mental or intellectual disability, disorder, disease or illness
• a physical injury or disease
• a serious addiction to drugs or alcohol
• homelessness
• family violence
• delay caused by a person representing a Worker might constitute an exceptional circumstance depending on the reasons for and length of the delay

Examples of exceptional circumstances in practice

1. The Agent rejected Nadia's claim for compensation on 5 May 2023. Nadia applied for Conciliation on 1 July 2023 and the Conciliator issued a Certificate of Genuine Dispute on 5 September 2023. Nadia’s home was flooded on 29 September, she could not return home until 10 October and the clean-up took two weeks. Nadia applied for a WCIRS review of the Agent’s decision on 2 November 2023.

   WCIRS accepted Nadia's late application for review because the flood, resulting homelessness and clean-up were circumstances outside of Nadia’s control which she could not have prevented or accommodated, significantly affecting her ability to apply for a WCIRS review in time.

2. The Agent rejected a request from Sunjeev's doctor to pay for knee surgery on 15 March 2023. Sunjeev applied for Conciliation on 15 August 2023. The Conciliator issued a Certificate of Genuine Dispute on 16 October 2023. Sunjeev applied to WCIRS on 13 November 2023.

   WCIRS accepted Sunjeev's application although it was more than 6 months after he became aware of the Agent’s decision because he had applied for Conciliation within 6 months, the time taken to complete Conciliation was outside of Sunjeev's control and he applied to WCIRS within 30 days of the GDOC.

3. Jessie had an accepted claim for Anxiety and Depression. The Agent emailed Jessie on 10 June 2023 about terminating their weekly payments on 9 September 2023. Jessie's doctor had provided the Agent with a medical certificate that they were fit for part-time modified duties and the Agent's independent medical examiner said that Jessie's mental injury was mild and did not prevent them from full-time work.

   Jessie applied for Conciliation on 30 August 2023. The Conciliator issued a Certificate of Genuine Dispute on 10 October 2023. Jessie applied to WCIRS on 29 November 2023. Jessie explained in the WCIRS application form that their mental injury prevented them from lodging the application any earlier.

   WCIRS did not accept Jessie's late application because it was made more than 30 days after the GDOC and the medical evidence did not support that Jessie's mental injury significantly contributed to delay in applying for a WCIRS review. Jessie could still apply for arbitration or dispute the decision in court.

4. As per example 3, but Jessie provided WCIRS with a letter from their psychologist explaining that Jessie had severe anxiety and depression, difficulty concentrating, making decisions, or remembering information and suffered from persistent fatigue and brain fog which caused significant delay in applying for a WCIRS review. WCIRS accepted Jessie’s late application because there was medical evidence supporting their mental injury had significantly contributed to the delay in applying for a WCIRS review.

5. Jenny disagreed with the Agent's calculation of her weekly payments dated 15 February 2023. Jenny's representative applied for Conciliation on 22 March 2023. The Conciliator issued a Certificate of Genuine Dispute on 19 April 2022. Jenny asked her representative to apply to WCIRS on 11 May 2023. WCIRS received the application on 23 August 2023. WCIRS did not accept the application because it was made 4 months after the GDOC was issued and there was no explanation for the representative’s delay. Jenny could still apply for arbitration or dispute the decision in court.

6. As per example 5 but Jenny's representative applied to WCIRS on 22 May 2023 and explained that they had been hospitalised due to COVID during the week of 15 May. WCIRS accepted the late application because it was made 33 days after the GDOC, Jenny was not responsible for the short delay and the representative had provided a reasonable explanation why the WCIRS application had not been lodged in time.

This policy will be reviewed after 14 July 2023.