Hurt at work, and unsure what happens now
Information about the New South Wales workers compensation scheme, for people who are off work or in dispute with an insurer.
Claims under the NSW workers compensation scheme
Disputes in the Personal Injury Commission
The sequence, in outline
A workers compensation claim moves through a sequence of steps, and several of them have their own time limit.
The injury is notified
An injury is notified to the employer, who notifies the insurer. Notifying late can make a claim harder to run, even where it remains open.
A claim is made
A claim is made to the insurer, usually with a certificate of capacity from a treating doctor.
The insurer decides
The insurer decides on liability, on weekly payments and on medical expenses. Those decisions are made in writing and can usually be disputed.
A dispute goes to the Personal Injury Commission
Disputes about a decision are dealt with by the Personal Injury Commission rather than by a court in the first instance.
Tell your employer early, and keep the paperwork
The period that applies to you depends on the kind of claim, the injury and when it was notified. Confirm the period that applies to you before you rely on it. Bring your certificate of capacity and anything the insurer has sent you.
Where a workers compensation claim can go
Payments while you are unable to work or can only work reduced hours, and what happens when the insurer reassesses your capacity.
Funding for treatment, and what happens when an insurer declines to approve something a doctor has recommended.
When an insurer disputes that an injury arose out of employment, or that employment was a significant contributing factor.
How permanent impairment is assessed, and why the assessment affects what else is available.
Claims against an employer in negligence where the scheme allows them, which depend on impairment and on fault.
Suitable duties, return-to-work plans, and what an employer is and is not required to do.
The insurer is not your adviser
An insurer administering a workers compensation claim has obligations under the scheme, and many of the people who work at one are helpful and straightforward. None of that makes them your adviser. They act for the insurer, their decisions are theirs to make, and the questions they ask are asked for a reason.
That matters most in the medical material. What is recorded about your injury, when, and by whom is part of what a claim is assessed on, so each certificate of capacity is worth reading rather than filed unread, and worth raising if something in it does not match your own account of what you can do.
It matters again when capacity is reassessed. A decision that you can work more hours than you can is still a decision, and it takes effect unless it is disputed.
Understanding your options
The available pathways depend on the date and circumstances of the injury, your assessed work capacity and any decisions made by the insurer.
- Weekly payments and medical expenses may cover lost earnings and reasonably necessary treatment for eligible workers. The amount and duration depend on the scheme and your circumstances.
- Permanent impairment compensation may be available after an assessment of a stabilised injury, where the requirements and threshold for your claim are met.
- Work injury damages may be available where the employer was negligent and the scheme requirements are met. This is a separate claim from weekly payments.
- Review pathways may be available if you disagree with an insurer’s decision. The appropriate process depends on the type of decision.
Real conversations.
Clear next steps.
Explain where you are now, ask the questions that matter to you, and understand what to prepare next.
Recognition of
Jameson Law.
Recognition received by Jameson Law and its team. My Workers Comp Lawyer is a service of Jameson Law. Award years and categories are shown on the original badges.
Early on, these matter most
Notifying an injury at work
Who to tell, what to say, and why the first certificate matters more than it looks. Also on this site: what to have ready before you talk about a claim.
Certificates of capacity
What the certificate does, and what happens when it changes.
When a decision goes against you
What an insurer’s decision is, and what can be done about one.
Common questions
Do I have a claim if the injury was partly my fault?
Workers compensation is generally available without proving fault, and fault matters for some parts of the scheme and not others. Whether it applies to your injury is a question for someone who can read the documents.
Can I be dismissed for making a claim?
There are protections in this area, and they are not unlimited. If you are worried about your job as well as your injury, say so early, because the two questions run on different timetables.
Do I need a lawyer?
Often not. Free assistance with workers compensation disputes is available in New South Wales, and many claims are dealt with directly with the insurer.
What should I bring?
The claim number if you have one, your certificates of capacity, anything the insurer has sent you, and the names of the practitioners treating you.
Tell us what has happened
A short summary is enough to begin. Please do not send medical records before a conflict check.