Reason Code
Glossary
Additional Compendium Filters Are Now Here!
Search efficiency and value are our top priority. With this in mind, you will now see:
- Reason codes added to search filters as a further layer of information that describes why a decision is made in a certain way
- Search result to display associated items in dispute, along with the For/Against Outcome and Reason Code for each line item
Reason Code Definitions
| # | Reason Code | Definition: When the Adjudicator considers/references/finds/prefers |
| Reason | A cause, explanation, or justification for an action or event for either party as described by the Adjudicator | |
| 1 | Adverse Inference | A legal inference, adverse to the concerned party, made from a party’s silence or the absence of requested evidence |
| 2 | Applicant’s Affidavit | The Applicant’s written testimony is relied upon/preferred in reaching a decision |
| 3 | Applicant’s Assessor Preferred | The conclusion of the Applicant’s assessor is preferred |
| 4 | Applicant’s Evidence Preferred | Applicant’s Evidence of a non-medical nature (e.g. witness, accountant, family member) |
| 5 | Applicant’s Medical Records/CNRs | When the Applicant’s medical records/CNRs/progress report from clinic are relied upon in reaching a decision |
| 6 | Causation | If the Applicant’s injuries/impairment arose as a direct result of the accident |
| 7 | Compliance | A party did or did not comply with the relevant section of the legislation; e.g, the Respondent did not comply with a denial notice (s.38(8)) and the Appplicant is therefore removed from the MIG; Could also be a reason in granting an award |
| 8 | Credibility | The believeability of the evidence/testimony of a party/witness; e.g. lack of consistency with the Applicant’s self-reporting) |
| 9 | Credibility of Assessor | The conclusion of the assessor does not match the findings of the assessment |
| 10 | Duplicative | Proposed treatment/assessment duplicates the one(s) that has already been submitted/approved |
| 11 | Entitlement | Interest is granted on overdue payments having determined entitlement |
| 12 | Evidence Not Heard | Applies to null issues where evidence was not heard/addressed because the issue is void/withdrawn; e.g. the Applicant was found to be within the MIG and a determination on the subsequent disputed benefits was unnecessary as determined by the Adjudicator |
| 13 | Failure to continuously adjust | Applies to findings of an award; when an award is granted on the basis that the Respondent failed in its obligation to continuously adjust the claim |
| 14 | Fees/Maximum Fees Allowable | Entitlement is found/not found based on the maximum fees allowable in accordance with the Professional Services Guideline |
| 15 | Insufficient Evidence | Not enough evidence provided to support position |
| 16 | Jurisdiction | The Tribunal’s power to make a decision |
| 17 | MIG Conceded | The Applicant is entitled to the remaining amount because they can no longer rely on the MIG, or the MIG was subsequently conceded. |
| 18 | No Evidence Submitted | No evidence provided to support submissions |
| 19 | Procedural Fairness | Prejudice to a party outweighs those to the other party |
| 20 | Respondent’s Assessor Preferred | The conclusion of the Respondent’s assessor is preferred |
| 21 | Respondent’s Evidence Preferred | Respondent’s Evidence of a non-medical nature (e.g. witness, accountant, family member) |
| 22 | Statutory Interpretation | Relevant statutes and or interpretation; e.g. Definition of Accident/Automobile decisions |
| 23 | Totality of Evidence | All evidence from both parties point the Tribunal to the same conclusion. This to be considered as evidence of a medical nature. |
| 24 | Treatment progress/recovery | An individual’s response to treatment as recorded/reported in determining entitlement |
| 25 | Unreasonably delay/withholding | Applies to findings of an award; when an award is granted on the basis that the Respondent took unreasonable steps in delaying/withholding payment of benefits |
| Reconsideration Reason codes: | ||
| 1 | Error of Fact or Law | Whether or not the Tribunal made a significant error of fact or law in reaching their decision. It is reasonable to assume that the Tribunal would have reached a different decision had the error not been made. |
| 2 | False/Misleading Evidence | The Tribunal heard false or misleading evidence during the trial, which likely affected the decision. |
| 3 | Jurisdiction | Whether or not the Tribunal acted within their Jurisdiction when rendering a decision |
| 4 | New Evidence | When New Evidence is provided to support submissions. This evidence could not reasonably have been obtained earlier, and would likely have changed the result of the trial. |
| 5 | No Evidence Submitted | No evidence provided to support submissions |
| 6 | Procedural Fairness | Whether or not the Tribunal violated the rules of natural justice and/or procedural fairness |