How to complete and lodge

When do I lodge a Request for Conciliation?

A Request for Conciliation Form must be lodged within 60 days of receiving a decision about your claim that you wish to dispute.  Where there is a formal decision by an Employer, VWA Agent or Self Insurer it should be attached to the Request for Conciliation Form.

A Request for Conciliation may also be made on the basis that the employer, VWA Agent or Self Insurer has failed to respond to a request made by you or on your behalf. 

Information that must be supplied where possible with the form

The request form must be personally signed. It must state clearly the details of the dispute and, where possible, be accompanied by:

  • a copy of the letter advising of the decision;
  • the "reasons for decision" attached to the letter; and
  • anything else which may assist to resolve the dispute, eg medical reports, copies of accounts or receipts, payslips etc.

You must produce all documents in your possession, custody or power and disclose all information to the Conciliation Officer that:

  • relates to the dispute; and
  • is reasonably available to you

unless you claim privilege or immunity from producing the document or disclosing the information.

Information provided may be given to other parties to the conciliation. (See our privacy policy.) We will not provide your medical information to your employer.

More than 60 days since the decision was received?

The Senior Conciliation Officer may allow the application to be lodged more than 60 days after the decision if the particular circumstances are considered appropriate. Reasons for a late lodgement must be provided with the request form.

Need more information?

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