Why a Complete Review Matters

Workers compensation decisions can only be as sound as the information available when the decision is made.

The experience behind MAKAL includes many years of reviewing complex claims, identifying gaps in decision-making and determining what further information may be required before a matter can be properly assessed.

In one complex matter, an insurer had accepted a workers compensation claim. On reviewing the determination, I identified significant gaps in the medical and factual information that had been relied upon and raised concerns about whether the available evidence supported the decision.

The employer was initially hesitant to challenge the determination. I clearly identified and explained the evidentiary gaps and was then given the opportunity to undertake a comprehensive review of the matter.

Further relevant medical and factual information was obtained, assessed and submitted to the relevant Regulator in support of a review of the insurer’s decision. Following its review, the Regulator overturned the original determination and the claim was rejected.

The importance of that matter was not simply the outcome. It demonstrated the value of independently examining how a decision has been reached, recognising when relevant information is missing and having the experience to know what further enquiries may be required.

This is one example of the complex review work that informs MAKAL’s approach today. MAKAL brings that same discipline to each matter: understanding the evidence already available, identifying genuine gaps, asking the right questions and helping ensure significant decisions are made on the most complete and relevant information reasonably available.