Disputes about Eligibility

You have the right to dispute our decision about your eligibility for the Scheme.

There are two types of eligibility disputes:

  • dispute about eligibility
  • dispute about motor accident injury or workplace accident injury

A dispute about eligibility is when you disagree with our decision on whether your injury meets the criteria for participation in the Scheme. This is a medical dispute which will be assessed by medical or other health professionals.

A dispute about motor accident injury or workplace accident is when you disagree with our decision on whether your injury meets the legal definition of 'motor accident injury' or a ‘work injury’. This is a legal dispute which must be decided by a panel of legal professionals.

An eligibility dispute application:

  • must be lodged within 6 months of receiving the eligibility decision
  • can only be made where the injured person or the insurer disputes the eligibility decision
  • must be lodged in writing

Once the dispute application is received, an assessments officer will be in touch to assist you through the dispute process.

Information sheets are available from the NSW Government Lifetime Care & Support Authority external lin which outline in more detail who can lodge a dispute, the process for lodging the dispute, and how disputes are resolved. These include:

  • Resolving disputes about your eligibility
  • Resolving disputes about a motor accident injury
  • Review of an Assessment Panel's decision about eligibility
  • Dispute assessors

Disputes about your needs once you're in the Scheme

Disputes about your treatment and care needs are different to eligibility disputes. See Disputes about your needs external lin

for more information.

Complaints

Disputes are different to complaints.

A dispute relates to a decision made by us about your eligibility or treatment and care. A complaint can be made about any aspect of our organisation, including our conduct or a service or product that's paid for by us.