South Australia’s return to work (workers compensation) scheme is regulated by ReturnToWorkSA. ReturnToWorkSA has a team and processes in place to manage complaints by workers and employers. Claims can also be managed by claims agents (Gallagher Bassett Services or Employers Mutual) or self-insured employers.
What kinds of complaints do we look into?
We deal with complaints about breaches of the Return to Work Act 2014 service standards by:
- self-insured employers and service providers engaged by self-insured employers
- claims agents.
The service standards set out what workers and employers can expect when engaging with these organisations.
We can also review ReturnToWorkSA’s handling of complaints about breaches of the service standards.
ReturnToWorkSA and other government self-insured employers are also covered by the Ombudsman Act. We can consider complaints about administrative error by those agencies.
Before contacting us
Before looking into your complaint, we need to know how you tried to resolve it with the organisation concerned. ReturntoWorkSA complaints explains how to make a complaint about a workers compensation matter.
Before we look into your complaint we expect you to:
- contact the organisation directly and discuss the problem with them
- follow their process for making a formal complaint if needed
- if the organisation’s response is not satisfactory, lodge a complaint with ReturnToWorkSA’s complaints team
Request a complaint review
Access to Return to Work claims files
Workers in South Australia can request access to claims files that concern them from ReturnToWorkSA or self-insured employers.
ReturnToWorkSA and self-insured employers do not have to provide access to certain material on claims files if any of the following apply:
- the material is relevant to the investigation of suspected dishonesty in relation to the claim
- the material is protected by legal professional privilege
- where the disclosure of the material could reasonably be expected to endanger the life or physical safety of any person.
If ReturnToWorkSA or a self-insured employer decides not to give you access to a claims file, you can apply to the relevant agency for an internal review of the decision.
If you are not satisfied with the results, you may ask Ombudsman SA to conduct an external review of the decision.
What can we review and when?
Our review is limited to whether or not the claims file you requested is subject to any of the three exemptions listed above.
The Ombudsman can confirm, vary or reverse the organisation’s original decision as a result of his review.
Before contacting us
Before we can consider your request for an external review, you must apply to ReturnToWorkSA or self-insured employer for an internal review of the decision and receive a written notification of the results.
Your request to the Ombudsman must be made within 30 days of your receiving that notification.
Apply for a claims file access review
If you would like to apply for a claims file access review, please complete the online form.