Regulatory
The decision notice summary is a SIRA approved form that insurers must attach when they issue a decision notice. It tells the worker what was decided and where to get advice on a disputed claim.
What the decision notice summary is
When an insurer makes a decision that results in a notice under section 78 of the Workplace Injury Management and Workers Compensation Act 1998, that notice must carry a summary in the approved form. SIRA approves and publishes the form. Its job is to make a technical decision readable: it states what the insurer decided and points the worker to the advice and assistance available if they disagree.
When it must be used
The summary applies whenever a decision produces a section 78 notice. That includes a decision to dispute liability and a decision to discontinue or reduce weekly payments. The requirement to issue the summary in the approved form has applied to section 78 decision notices since 1 July 2019, so it is a settled part of how disputes are communicated.
What the summary must contain
Under clause 38 of the Workers Compensation Regulation, the insurer must include, in the approved form, a summary of the legal and other services available to the worker to get advice or assistance in relation to the dispute. In practice the form sets out mandated wording for different decision types, so a worker facing a reduction in weekly payments and a worker facing a disputed liability decision each receive a summary matched to their situation, including how to seek a review and how to contact the Independent Review Office.
Why it matters to injury managers
A decision notice that is missing or misusing the approved summary is procedurally vulnerable. Getting the summary right is part of making a decision that will stand, and it signals to the worker that the process is fair and reviewable. For claims teams, the summary is a reminder that the quality of the underlying evidence, including any medical and medication evidence, is what a review will test if the worker challenges the decision.
Key Takeaways
- The decision notice summary is a SIRA approved form attached to a section 78 decision notice.
- It must be used whenever a decision disputes liability or discontinues or reduces weekly payments.
- The requirement has applied to section 78 decision notices since 1 July 2019.
- Clause 38 of the Regulation requires the summary to set out the advice and assistance available to the worker.
- A correct summary supports a decision that will withstand review.
Frequently Asked Questions
What is the decision notice summary?
The decision notice summary is a SIRA approved form that an insurer must include on the front of a decision notice given under section 78 of the 1998 Act. It sets out, in plain terms, what the insurer decided and what advice and assistance is available to the worker.
When must an insurer use the approved form?
The summary in the approved form must be issued whenever a decision results in a section 78 notice, such as a decision to dispute liability or to discontinue or reduce weekly payments. The requirement has applied to section 78 decision notices since 1 July 2019.
What must the summary contain?
Under clause 38 of the Workers Compensation Regulation, the summary must set out the decision and include information about the legal and other services available to the worker to get advice or assistance with the dispute, including the Independent Review Office.
Primary source: State Insurance Regulatory Authority (SIRA), Workers compensation decision notice summary: the approved form (approved under section 78 of the 1998 Act).
