Aki was confused and stressed. They said they were not on any performance plan and did not agree with the insurer’s reasoning. Without payments, they began to feel financial pressure.

In the workers compensation system, insurers can delay payments in some situations. However, they must have clear and strong evidence to support their decision. In Aki’s case, the insurer relied on a performance concern without proper proof.

Aki contacted the Independent Review Office (IRO). The IRO reviewed the information and found that the insurer did not have enough evidence to support its decision. The IRO explained to the insurer that claims about an injury not being work-related must be clearly supported, and any performance concerns must be backed by proper documentation.

After this, the insurer reviewed the claim again. They agreed there was not enough evidence to continue delaying payments. The insurer withdrew the reasonable excuse, accepted the claim on a provisional basis, and started weekly payments.

This meant Aki could begin receiving income support while continuing to recover. It also showed the importance of making sure decisions are based on evidence and that injured workers are treated fairly.

The IRO’s Service

Mei contacted the Independent Review Office (IRO).

The IRO reviewed the situation and identified that:

• The insurer had not properly calculated Mei’s weekly earnings
• Enough information may have been available to complete the calculation
• The delay was causing financial stress for Mei

The IRO asked the insurer to complete a PIAWE calculation in line with the law.