Form · Personal Injury & Compensation

Workplace Injury Commission application for conciliation: completion guide

Guide to the Workplace Injury Commission application for conciliation, including the 60-day period, the documents to attach, and the signature and authorisation in section 5.

Kind: Form. A form to complete, or a guide to completing an official one.
Where it applies: Victoria
AI use: Yellow You and the tool draft together, with you directing. You check every statement you rely on.
Law stated as at: 23 October 2026
Status: Maintained. Checked on 23 October 2026 against the official form at wic.vic.gov.au and the 2 authorities it cites, for Victoria.
Version: 1
Source: Link to the official form. Licence: © State of Victoria. Link only: download the current form from the official page each time; do not copy or adapt it.

Where this comes from

The official form is published by wic.vic.gov.au; this page is a completion guide. Last checked on 2026-10-23.

When to use it

Use when a worker disagrees with a WorkSafe agent or self-insurer decision, or the agent or self-insurer has not responded or paid within a reasonable time. The worker, or a person the worker authorises, completes the official form.

Used for these tasks

Each task page says how far AI may help with the task and what the lawyer must review.

How AI may be used

The tool may index the decision, the unanswered request or the unpaid certificates already on the file; the worker or an authorised person completes section 5 and the tool writes nothing in that declaration.

AI may

Index the decision notice, treatment request, unpaid certificates of capacity, or unpaid invoices already held
Diary 60 days from the decision date the lawyer confirms
Note whether the file records a request for an interpreter, including the language, or for disability assistance

AI must not

Must not write or sign section 5, including the authorisation to lodge and to communicate with the Commission
Must not argue the dispute in the form
Must not decide that a late application will be accepted
Must not complete the Application for Further Conciliation. That form was not opened

The lawyer checks

The dispute is a decision the worker disagrees with, or a failure to respond or pay within a reasonable time
The form asks for reasons if it is more than 60 days since the decision. The conciliation page says late applications can be considered if a reason is given
At least one of the listed documents is attached
A person lodging for the worker has the worker's authorisation, and completes the contact block
A lawyer who will attend the conference has the Commission's permission. WorkCover Assist, Union Assist, another union, or the worker's own lawyer can help
The Commission arranges a free interpreter, including Auslan. A support person cannot interpret
Health information stays in a firm-controlled tool. Check ASCR r 9, APP 11, and whether any disclosure would be a notifiable breach under the Privacy Act 1988 (Cth).

Method: how the Green, Yellow and Red levels are decided. This is guidance for planning, not legal advice.

Authorities

Official form

Open the official form. Always use the current version from the issuer. Licence: © State of Victoria. Link only: download the current form from the official page each time; do not copy or adapt it..

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