When an MAI insurer makes a decision about your application, or the defined benefits that are paid to you or on your behalf, they must write to you with their decision and the reasons for that decision. The letter will also tell you if you can ask for that decision to be reviewed.
Most, but not all, of the decisions an MAI insurer makes about your application can be reviewed if you consider the MAI insurer has made an incorrect decision. These include when the MAI insurer has rejected your application for defined benefits or rejected a request for certain benefits (eg. a certain aid or appliance recommended for you).
If you want the decision to be reviewed you must write to the insurer within 28 days after the date of their decision, explaining that you want the decision reviewed and why. If you need more time to request the review, you must write to the insurer as soon as practicable explaining why the additional time is required.
Once your request for internal review has been received the MAI insurer has 10 business days to review the decision. The MAI insurer has more time to undertake the review in certain circumstances, such as the MAI insurer considers there is a need to request additional information or documents. The MAI insurer will then write to you with the outcome and the reasons for that decision. This letter will also tell you if you can request an external review of the decision by the ACT Civil and Administrative Tribunal (ACAT) if you are still unhappy with their decision. You can visit the ACAT website for information on making an application for external review.
If you wish to make an application to the ACAT, there is an application fee that you will have to pay (you may request a fee waiver in certain circumstances). Please note that the ACAT is a jurisdiction where the parties normally bear their own costs. The ACAT has a limited ability to award costs and there is no guarantee you will be able to recover any costs you incur in making your application to the ACAT even if the tribunal decides in your favour.
If you need help understanding how to dispute an insurer’s decision contact the free Defined Benefits Information Service on 1300 209 642 or by email to DBIS@carefcs.org.