Record what a Queensland insurer's decision file actually shows
MaintainedLast reviewed
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- From the insurer's letter and the file notes the lawyer supplies, table the decision, the date it was received, whether written reasons were requested, and whether the decision is one the review page treats as reviewable. Copy only what the documents say. Do not infer that an algorithm made the decision.
- What the lawyer must review
- Decide whether the decision is reviewable under s 540, or only a complaint.
- A decision not to fund a particular procedure is not reviewable on the page opened.
- Count 20 business days for reasons and 3 months for a review from the dates received.
- Use a firm-controlled tool. Check ASCR r 9, APP 11 and any notifiable breach.
Rules that apply
The document starts from the task name. Change it if this piece of work is different.
The work product
Forum. WorkCover Queensland or a self-insurer, then the Workers' Compensation Regulator
Produce. A decision table limited to what the file states, with the review dates calculated from dates the lawyer confirms.
Have ready. Insurer's written decision; File notes of any phone call or portal message; Date the worker was advised; Date the written decision was received.
Example of the limit. Illustrative example: The letter rejects the application and gives no score or model. The table records the rejection and the two dates. It does not say a program made the decision.
Stop and hand it back when
- The only basis for an algorithm is a guess.
- The decision is about ongoing medical management or funding one procedure, which the page says is not a review.
Sources for this task were checked on 2026-10-23.
Who does what
| Role | What they do |
|---|---|
| Assistance | From the insurer's letter and the file notes the lawyer supplies, table the decision, the date it was received, whether written reasons were requested, and whether the decision is one the review page treats as reviewable. Copy only what the documents say. Do not infer that an algorithm made the decision. |
| Lawyer | Set the scope, supervise the work closely, verify every part relied on, resolve omissions and exceptions, and approve the exact output. |
Checklist
- Record the decision type and the date the worker was advised, separately from the date the written decision was received.
- Do not describe a tool, score or model unless the document names it.
- Check the review page's examples of decisions that are and are not reviewable.
- Do not draft the review application.
Sources
- WorkSafe Queensland: independent review of insurer decisions · 2026-10-23
- WorkSafe Queensland: guide to appealing a review decision · 2026-10-23
- Queensland Industrial Relations Commission: workers' compensation · 2026-10-23
Health, wage and benefit records stay in a firm-controlled tool. Check ASCR r 9, APP 11, and whether a disclosure is notifiable under the Privacy Act 1988 (Cth).
No Queensland statute on insurer automated decision-making was opened. The review path is the one stated by WorkSafe: ask the insurer for a reasons-for-decision document within 20 business days of being advised of the decision, then lodge a review with the Office of Industrial Relations within 3 months of receiving the insurer's written decision. The review officer does not re-investigate the claim.