A plain guide to the steps an injured worker in New South Wales takes to make a workers compensation claim, from telling the employer to the insurer's decision.
If you are injured at work in New South Wales, you tell your employer, see a doctor, and lodge a claim with your employer’s workers compensation insurer. The insurer then decides whether to accept the claim and, if it does, pays for reasonable medical treatment and part of your lost wages.
This guide is for someone who has never made a claim before. It explains the general shape of the process, not the outcome in any one case.
Who is involved
Employers in New South Wales must hold a workers compensation policy. The scheme is regulated by the State Insurance Regulatory Authority, known as SIRA, and the main scheme is managed by iCare (Insurance and Care NSW). Day to day claims are managed by the insurer of the workers compensation policy held by the employer, or by its own insurer where the employer is self insured.
The main laws are the Workers Compensation Act 1987 and the Workplace Injury Management and Workers Compensation Act 1998. Your employer’s policy details, and the insurer’s name, should be available from the employer or from the insurer’s claims contact details.
Step 1: notify your employer
Notify your employer about the injury as soon as you can, and make sure it is recorded in the workplace injury register. A written note or email is useful because it fixes the date you raised it. Employers are required to pass injury notifications on to their insurer, but you should not assume that this has happened.
Report the injury even if it seems minor. Some injuries become worse over days or weeks, and a late report can create avoidable arguments about whether the injury happened at work.
Step 2: see a doctor and get a certificate
Ask your doctor to record how the injury happened and to complete a workers compensation certificate of capacity. The certificate is the key medical document in the scheme. It describes the injury, what work you can and cannot do, and for how long.
You will usually choose a nominated treating doctor, who then manages your certificates. Certificates need to be renewed as your capacity changes, so keep every one and give copies to your employer and the insurer.
Step 3: lodge the claim
A claim is made by completing a workers compensation claim form and giving it, together with the certificate of capacity, to your employer or directly to the insurer. Your employer then sends it on. Keep a copy and note the date you handed it to your employer.
Claims need to be made within certain time limits, and delay can cause problems with evidence as well. Our guide to time limits for personal injury claims explains how these limits generally work, and getting advice promptly is wise.
You can lodge a claim yourself on iCare’s website if you are unsure as to whether your employer has notified the insurer.
Step 4: what the insurer does
Once the claim arrives, the insurer investigates. It may ask for medical records, speak to your employer and to witnesses, and ask you to attend an examination with a doctor it chooses. Strict timeframes set by the regulator apply to how quickly the insurer must respond.
In some circumstances the insurer may start provisional payments of weekly compensation and medical expenses while it looks into the claim. Provisional payments do not mean the claim has been accepted. The insurer can still decide later to dispute the claim.
The insurer’s decision will be one of these:
| Decision | What it generally means |
|---|---|
| Accepted | The insurer agrees the injury is work related and starts or continues benefits |
| Accepted in part | Some conditions or benefits are accepted and others are not |
| Declined or disputed | The insurer says it is not liable and must give reasons in writing |
What the scheme can pay for
If the claim is accepted, the scheme has several parts.
- Medical and related expenses. Reasonable and necessary treatment, such as physiotherapy, surgery, medication and travel to appointments, subject to the rules of the scheme.
- Weekly payments. Payments to replace part of your income while you have an incapacity for work. The amount and how long it lasts depend on your circumstances and on the scheme rules, which change over time.
- Lump sum compensation. A payment for permanent impairment, which depends on an assessment of the injury. Our article on whole person impairment explains how impairment percentages are generally worked out.
- Work injury damages. A separate claim against an employer for negligence, available only in limited circumstances and subject to its own requirements.
Nothing here is a promise of any amount. What you receive depends on the medical evidence and the law that applies to your injury.
If the insurer says no
A declined claim is not the end. The insurer must give written reasons, and there is a process for asking the insurer to review its decision. If that does not resolve it, a dispute can be taken to the Personal Injury Commission, which decides workers compensation disputes in New South Wales. Strict timeframes apply to each step, so do not wait before getting advice.
Decisions about your capacity for work and your weekly payments can also be reviewed. Keep every letter the insurer sends you, because the reasons in those letters matter.
What to do next
Tell your employer, see your doctor, and keep copies of everything: the claim form, certificates, letters and receipts. Then lodge the claim without delay.
If you are unsure whether you have a claim, or the insurer has delayed, reduced or declined your payments, you can check your entitlement or contact our Sydney office to talk it through.