Dispute Resolution

Insurer Based Disputes

Insurers, insurance agents, or local regulators maintain authority over medico-legal aspects of claims and injury management.

These areas include though are not limited to:

  • Determination of liability;
  • Permanent impairment / common law proceedings;
  • Determination of reasonable and necessary treatment; and
  • Claim finalisation.

Compass Care has no or limited authority with respect to medico-legal aspects of claims and injury management.

Disputes that arise in these areas will be referred to the relevant insurer, insurance agent, or local regulator (as relevant in that jurisdiction).

Unresolved Insurer Based Disputes

Should an ‘insurer based dispute’ remain unresolved or not resolved to the satisfaction of those involved, the Compass Care team should be notified. Further review will be conducted in a timely manner and those parties involved notified of the findings or determination.

Employer Based Disputes

The aim of ‘employer based dispute’ management is, via collaboration and consultation, to reach a mutually agreeable resolution whereby all parties can proceed with the shared goal of returning our injured or ill employee to their pre-injury duties in a safe and timely manner.

‘Employer based disputes’ can include though are not limited to:

  • Offers of suitable duties;
  • Coordination of return to work;
  • Development of return to work documentation;
  • Compliance with medical restrictions; and
  • Payment of weekly benefits.

Hierarchy for Dispute Management

The following hierarchy should be applied for ‘employer based dispute’ resolution (with respect to claims and injury management).

Consult the following parties in an endeavour to resolve the matter in a timely and effective manner:

  • Your Manager or Supervisor;
  • The Compass Care team;
  • General Manager – Compass Care;
  • Director of Human Resources & Risk; and
  • External parties.

If a dispute remains unresolved for an unreasonable period, the matter should be referred to the next level of the hierarchy for resolution.