WorkSafe Victoria has challenged a finding that the workers’ compensation scheme and its agents may have acted incorrectly when handling claims.

A letter outlining CEO Clare Amies’ objections features in the Victorian Ombudsman’s 174-page report on the state’s management of complex claims.

The report, released last week, is highly critical of the scheme’s dispute resolution process and the way agents ignored evidence to deny workers their rightful entitlements.

“You have not invited us to comment on your proposed conclusions, but I would like to put on record that we consider that they substantially overreach the limited evidence considered in the course of your investigation,” Ms Amies says in the letter.

“We particularly object to your conclusion that agents may have acted contrary to law or that WorkSafe appears to have acted in a way that was ‘wrong’. We do not accept that the evidence justifies these conclusions and we believe that insufficient weight has been accorded to the matters referred to in this letter.

“We point in particular to the general level of satisfaction with claims handling, as indicated by survey results.”

Victorian Ombudsman Deborah Glass investigated 65 complex claims decisions in which the scheme’s five agents – Allianz, CGU, Gallagher Bassett, Xchanging and QBE – rejected or terminated entitlements in 2014/15 and 2015/16. QBE ceased being an agent on June 30.

Her report says complex claims make up just 20% of those received each year, but account for 90% of the scheme’s liabilities.

“The overall system is not broken, but the problems we identified in complex cases… go beyond a few isolated examples of bad behaviour,” Ms Glass says in the report. “Action must be taken to address the complex end of the system where terminations are rewarded.

“The process for resolving disputes also demands careful reconsideration – it is in the interests of workers, employers and the public at large that the resolution of claims should be both timely and fair.”

WorkSafe has started to address the issues and made improvements since the investigation started last year, but much remains to be done. “This work must go on,” Ms Glass says.

A CGU spokesman told insuranceNEWS.com.au the insurer is working with WorkSafe to “refine our model” of managing workers’ compensation.

It has also acted to improve support for customers with mental health issues, strengthen protocols and procedures on the use of independent medical experts and revisit recent changes to its claims review process.