What happens if my workers comp claim is denied in NSW?

A declined claim, a declined treatment request or a cut to your weekly payments are not the end of the road. Here is the real dispute and review process, and the free help available along the way.

A denial in the NSW workers compensation system can mean a few different things: the insurer declining liability for the claim altogether, declining a specific treatment or treatment request, or a work capacity decision that cuts or changes your weekly payments. Each has the same broad path available to you: ask the insurer to look again, get free independent help, and if it is still unresolved, take it to an independent tribunal. You do not have to navigate any of this alone.

Step 1: Ask the insurer to review its own decision

You (or someone acting for you) can request an internal review of the insurer's decision. This review is carried out by someone other than whoever made the original decision. Include any extra information that supports your case when you request it. The insurer must respond in writing within 14 days.

This step matters beyond just the immediate answer: if the dispute later goes to the Personal Injury Commission, generally only the insurer's original decision notice and the documents you submitted for this review are considered, unless there are exceptional circumstances. Put everything relevant in at this stage.

Step 2: Get free help from the Independent Review Office

The Independent Review Office (IRO) is a free, independent statutory office that can contact the insurer on your behalf and help resolve the dispute informally, at any stage of the process. If the dispute remains unresolved, the IRO can also help you find a lawyer approved under the Independent Legal Assistance and Review Service (ILARS), which may fund legal help to take the matter further.

Contact the IRO on 13 94 76 or email [email protected].

Step 3: Apply to the Personal Injury Commission

If you are dissatisfied with the insurer's decision, whether or not you sought a review first, you can apply to the Personal Injury Commission (PIC), an independent tribunal that resolves workers compensation disputes between workers, employers and insurers. It handles disputes about work capacity decisions, weekly payments, medical and treatment expenses, permanent impairment compensation, suitable work and more. The exact procedure depends on what is in dispute.

Contact the PIC on 1800 742 679, Monday to Friday, 8:30am to 5pm (excluding public holidays).

If the dispute is about a work capacity decision that reduces or stops your weekly payments, applying to the PIC before the notice period on the insurer's decision expires can 'stay' (temporarily suspend) that decision, meaning your payments may continue while the review is underway. The IRO or your case manager can explain how this applies to your situation.

If the dispute is about your return to work, not liability

A different type of dispute covers injury management: no return to work plan, a plan that is not being followed, no suitable duties being offered, or disagreement about your capacity to work. Start by asking the insurer to help resolve it, including engaging an injury management consultant or workplace rehabilitation provider if useful. If the dispute is about your employer's obligation to provide suitable work, SIRA can also help on 13 74 72. From there, the same option to apply to the Personal Injury Commission is available.

This is general information, not legal advice, and NSW workers compensation has been through recent reform, so processes and contact details can change. This page reflects SIRA and Independent Review Office guidance current at the time it was checked; use the sources below, or call the IRO, to confirm your specific situation.

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