The workers compensation claims process, step by step

From reporting the injury to your first approved treatment, here is the sequence most NSW workers compensation claims follow, and the timeframes insurers are expected to meet.

Filing a workers compensation claim in NSW follows a fairly predictable sequence, even though it rarely feels that way from the inside. Knowing the order of events, and the timeframes insurers are expected to work to, makes it easier to tell whether your claim is moving normally or has stalled somewhere it should not have.

1. Report the injury

Tell your employer about the injury as soon as possible, including when and how it happened. Your employer is then required to notify its workers compensation insurer, generally within 48 hours of hearing from you. This starts the clock on the insurer's own response timeframes.

2. The insurer makes contact

The insurer is expected to write to you within 7 days of being notified of the injury, setting out what happens next and what it needs from you. Around this point you will usually also submit a completed claim form.

3. Certificate of Capacity

Your nominated treating doctor issues a Certificate of Capacity describing what you can and cannot currently do. This document supports both your claim and any weekly payments, and it needs to be kept up to date as your capacity changes. If a certificate lapses, the insurer can pause weekly payments after giving you 7 days' notice that a new one is required. See the guide on the Certificate of Capacity for what the form includes and who can issue one.

4. Provisional liability

Insurers generally decide within 7 days of being notified of the injury whether to start provisional payments, covering weekly payments and treatment while they investigate further. Provisional acceptance is not the same as a final decision on your claim. If the insurer needs more information before it can make that final decision, it generally has a further period after receiving that information (commonly described as up to 21 days) to determine liability.

5. Your first treatments

You can access reasonably necessary treatment within 48 hours of the injury without waiting for insurer pre-approval. Beyond that early window, a SIRA-approved treater such as a physiotherapist, exercise physiologist or psychologist can generally provide a first block of sessions, often described as the first 8 consultations, without a separate approval request, provided treatment starts within the relevant timeframe of the injury. The exact number of sessions and the conditions attached can vary, so confirm the current position with your treater or case manager rather than assuming it always applies.

6. Ongoing approval

If you need more sessions than the initial pre-approved block, your treater submits an Allied Health Treatment Request to the insurer, setting out why further treatment is reasonably necessary. Where your return to work is not straightforward, a workplace rehabilitation provider may also be brought in around this stage to coordinate a return to work plan alongside your ongoing treatment. See the guide on the return to work process for what typically happens from here.

What this costs you

For an accepted claim, treatment from a SIRA-approved provider should not cost you anything out of pocket. The insurer pays approved providers directly under the scheme's fee arrangements, whether that treatment falls inside the initial pre-approved sessions or has been approved through an Allied Health Treatment Request. If a provider asks you to pay upfront for treatment related to your injury, raise it with your case manager before you pay.

NSW workers compensation has been through recent reform, so exact timeframes and thresholds can shift. This page reflects SIRA and Independent Review Office guidance current at the time it was checked; always confirm anything time-critical with your case manager or the sources below.

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