A WorkCover claim rejected in Queensland arrives with two things the Act requires the insurer to produce: written reasons for the decision, and information about the review rights that attach to it. The reasons tell you what was decided and on what basis, and the review clock does not start until you have them.
What happens next is set out in chapter 13 of the Workers’ Compensation and Rehabilitation Act 2003 (Qld). The pathway has a fixed shape: a check inside the insurer before the decision issues, a review by the Workers’ Compensation Regulator afterwards, an appeal to the Queensland Industrial Relations Commission, and a further appeal to the Industrial Court. Each stage has its own decision-maker, its own powers and, at the review and appeal stages, a strict time limit.
What the insurer must do before and after a rejection
Before an insurer rejects an application for compensation or terminates compensation, it must undertake an internal review of the proposed decision, and that review must be done by someone more senior than the person proposing to make it (s 538). That happens before you see anything, so a rejection letter has already passed a second set of eyes.
Once the decision is made, the insurer must give written reasons for it, or for a failure to make it. Those reasons must address the matters a regulation prescribes and be accompanied by information about the rights of review that apply (s 540(2), (4)). Such a decision may be reviewed only by the Workers’ Compensation Regulator (s 540(5)).
“Insurer” means WorkCover or a self-insurer, so if your employer is self-insured the decision is made in-house but the pathway that follows is identical.
The pathway at a glance
| Stage | Who decides | Time limit to start | Powers |
|---|---|---|---|
| Internal review | A more senior person inside the insurer | Runs before the decision issues | Review the proposed decision (s 538) |
| Review | Workers’ Compensation Regulator | 3 months after you receive the decision and its reasons | Confirm, vary, set aside and substitute, or return with directions (s 545) |
| Appeal | Queensland Industrial Relations Commission | 20 business days after you receive the review decision | The same four options (s 558) |
| Further appeal | Industrial Court | Under the industrial relations legislation | Rehear on the evidence already given, unless it orders more (s 561) |
Applying to the Regulator for review
A claimant, worker or employer aggrieved by a decision, or by a failure to make one, may apply for review (s 541). The application goes to the Regulator in the approved form, must state the grounds relied on, and may attach any document you want considered; the Regulator must acknowledge it within 10 business days (s 542(5), (6)).
You may appear before the Regulator in person or be represented at your own expense, and may make representations by telephone or another form of communication (s 543).
The Regulator must decide within 25 business days of receiving the application (s 545(1)). It can confirm the decision, vary it, set it aside and substitute another decision, or set it aside and return the matter to the insurer with directions. That last option is confined: it needs information the insurer did not have, or a reasonable belief that it lacked satisfactory evidence or did not observe natural justice (s 545(1A)). The period can be extended, including where you ask in writing for time to put further information forward (s 545(4)). Written notice of the review decision, with reasons, follows within 10 business days (s 546(1)).
One provision is easy to miss: if the Regulator sets aside or varies a decision rejecting an application for compensation, the insurer must reimburse the cost of an examination by, and report from, a registered person that the worker obtained, where the Regulator considers they substantially contributed to that outcome (s 547).
The three-month clock, and what starts it
An application for review must be made within 3 months after you receive written notice of the decision and the reasons for it (s 542(1)). Notice on its own does not start the clock. The reasons have to be there as well.
If the notice arrived without reasons, a separate sequence applies. You must ask the decision-maker for them within 20 business days of receiving the notice, and written reasons must follow within 5 business days. Your 3 months then runs from the day you receive them, whether or not they addressed the matters the regulation prescribes (s 542(4)).
An extension is possible but narrow. You may ask the Regulator for further time at any time, but not more than once, and only special circumstances will support it (s 542(2), (3)). Work to the original date.
Appealing a review decision
A claimant, worker or employer aggrieved by the review decision may appeal (s 549(1)). For a review decision about a claim the appeal body is the Queensland Industrial Relations Commission; an industrial magistrate hears insurance and premium matters and non-reviewable decisions (ss 548 and 548A).
The deadline is 20 business days after you receive notice of the review decision (s 550(1)). An appeal is started only by filing a written notice of appeal, and where the appeal body is the industrial commission it is filed in the industrial registry (s 550(4), (4A)). You then have 10 business days from filing to serve a copy on the Regulator (s 550(6)). You may ask the respondent to allow further time (s 550(3)), but that is a concession, not a right.
Two rules shape the hearing. Each party must give the other every relevant document it wants to put in evidence at least 10 business days beforehand, and cannot rely on an undisclosed document unless the appeal body agrees (s 554). The appeal body may also order the worker to submit to a personal examination by a registered person, and any entitlement to compensation is suspended if the worker fails to attend without reasonable excuse, refuses examination or obstructs it (s 556).
The appeal body has the same four options as the Regulator, and costs of the hearing are in its discretion, except so far as a regulation provides (s 558). Its decision goes to each party in writing (s 559).
A party aggrieved by that decision may appeal to the Industrial Court, and the Industrial Relations Act 2016 (Qld) applies to that appeal. It is a rehearing on the evidence already before the magistrate or the commission, unless the court orders additional evidence, and the court’s decision is final (s 561).
Where this pathway does not go
A returned matter is not appealable. If the Regulator sets the decision aside and returns it to the insurer with directions, that outcome cannot be appealed (s 546(3A)). It is not a dead end: the insurer must decide again, and the fresh decision carries its own reasons and review rights.
Silence from the Regulator is appealable. If no review decision is made within the time allowed, you may appeal to an industrial magistrate against the failure to make it (s 546(4)).
Medical questions can leave the pathway altogether. An insurer may refer a worker’s application, capacity for work or permanent impairment to a medical assessment tribunal for decision on the medical matters involved (s 500(1)). That tribunal’s decision on a referred medical matter is final and cannot be questioned before a tribunal or a court, except on a further reference on fresh evidence, although the finality does not displace the Judicial Review Act 1991 (Qld) (s 515). That further reference has its own limits: the worker has 12 months from the original decision to ask the insurer to consider fresh medical evidence, and a review panel decides whether it is relevant and is factual medical data not known at the time (s 512).
What a rejection usually turns on
Rejections turn on a range of grounds. Three recur, and knowing which one is live shapes the evidence that matters.
Whether there is an injury within the Act. An injury is a personal injury arising out of, or in the course of, employment where the employment is a significant contributing factor (s 32(1)). Where the claim concerns an aggravation of something pre-existing, the aggravation must itself arise out of, or in the course of, employment, with employment a significant contributing factor to it (s 32(3)(b)), and the Act declares that the aggravation is an injury only to the extent of the effects of the aggravation (s 32(4)).
The management action exclusion. A psychiatric or psychological disorder is not an injury where it arises out of reasonable management action taken in a reasonable way by the employer in connection with the worker’s employment, out of the worker’s expectation or perception of reasonable management action being taken against them, or out of action by the Regulator or an insurer in connection with the worker’s application for compensation (s 32(5)). Whether action was both reasonable and reasonably taken is a question of fact, so these decisions turn on contemporaneous documents.
Whether the application was lodged in time. An application is valid only if lodged within 6 months after the entitlement to compensation arises, and lodging more than 20 business days after that point limits the insurer’s liability to a period starting no earlier than 20 business days before lodgement (s 131(1), (2)). An insurer must waive the 6 month limit where satisfied that special circumstances of a medical nature, decided by a medical assessment tribunal, exist (s 131(4)). It may also waive that limit where a doctor, nurse practitioner or dentist has assessed the injury as causing total or partial incapacity and the application followed within 20 business days of that assessment (s 131(5)), and may waive either limit where the failure to lodge was due to mistake, absence from the State or a reasonable cause (s 131(6)). A decision to waive or not to waive is itself reviewable (s 540(1)), so a refusal to excuse a late application is not the last word.
Published 2 September 2026.
If a decision has gone against you
The deadlines are short and counted differently at each stage: 3 months from the reasons at the review, 20 business days from notice at the appeal, 10 business days to serve after filing. Missing one does not always end the matter, because the Act carries extension provisions, but none operates automatically.
It also helps to be precise about which decision is in issue. A rejection, a termination, a reduction in weekly payments and a refusal to waive the lodgement time limit are separate reviewable decisions, each with its own clock (s 540(1)).
Related reading
- WorkCover claims in Queensland: the complete guide
- Independent medical examinations in Queensland: what to expect and your rights
- How Fraser Lawyers helps with WorkCover claims
- Contact Fraser Lawyers
Need advice? Time limits and key decisions in injury claims can be strict and easy to miss. If this is your situation, contact Fraser Lawyers to understand your rights and where you stand, with no obligation. |
This article is general information only and is not legal advice. Queensland law and the figures referred to can change, and every situation turns on its own facts. Contact Fraser Lawyers for advice specific to your circumstances.
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