When a decision goes against you
An insurer has written to you declining liability, stopping your weekly payments, or refusing to fund treatment your doctor recommended. That letter is a decision, and a decision can usually be challenged.
General information, not legal advice. This page sets out how the law generally applies. It does not take account of your circumstances, and you should get advice about your own situation before acting on it. The official sources this page is written from are listed on it; where they differ from anything here, they are the authority.
An insurer’s written decision is not the end of your claim. You can ask the insurer to review it, and if you are still not satisfied you can apply to the Personal Injury Commission of New South Wales.
Find the letter itself and write down the date on it. Periods here run from documents, and some of them are short.
What the insurer has sent you is a decision
The insurer decides, and it puts its decisions in writing. Declining liability is a decision. Stopping or reducing weekly payments is a decision. So is refusing to fund treatment your doctor recommended.
The Personal Injury Commission sets out when a worker can bring a dispute to it, and the list is wider than most people expect.
- A letter stating that all or part of the claim has not been accepted, or is no longer accepted.
- A letter accepting the claim where you disagree with the amount payable.
- The insurer has made no decision at all.
- Notice of a work capacity decision you disagree with.
- You and your employer cannot agree on an injury management plan or on your return to work.
Read the letter for what it decides, not for how it reads. A notice in routine language can still end a payment, and the period to act runs from the date printed on it.
Ask the insurer to review the decision
The Commission publishes that a worker who disagrees with all or part of an insurer’s decision has the right to request a review by the insurer before lodging an application, and that in some cases an internal review is required first. Which applies to you depends on what was decided.
An internal review is the insurer looking again at its own decision. It is not a hearing and the reviewer is not independent of the insurer, but it is often the quickest route where a report was never read. It does not relieve you of watching the other dates. And before any dispute can be lodged, a claim must first have been made on the employer or its insurer.
Where a dispute about a decision is decided
Workers compensation disputes go to the Personal Injury Commission rather than to a court in the first instance. Applications are lodged through its online Pathway portal, and the Commission then assigns the dispute to a pathway, which changes how it is run and who decides it.
- Legal disputes cover entitlement to weekly compensation, medical and related expenses, lump sums for permanent impairment, and death benefits. Issues can include whether an injury occurred, whether it happened at work, and whether work was a substantial contributing factor.
- Medical disputes are mostly about the degree of permanent impairment, assessed by an independent specialist appointed by the Commission.
- Expedited assessments are a faster route for some weekly payments and medical expenses disputes, disputed work capacity decisions, and workplace injury management disputes.
- Damages disputes are the work injury damages route, where mediation at the Commission is a mandatory step before court proceedings.
The Commission cannot resolve every dispute. It publishes that some classes of workers, including coal miners, volunteer rescue workers and workers with specified dust-related conditions, are dealt with by other agencies.
What happens once an application is lodged
In the legal disputes pathway the Commission starts with a preliminary conference, usually online, run by a member who has read the evidence. Many disputes are resolved there. If yours is not, it goes to a conciliation conference and, failing agreement, to an arbitration hearing the same day, where a member makes a binding decision.
In the expedited pathway a senior lawyer or member runs the conference and, failing agreement, issues an interim payment direction where the dispute is about weekly payments or medical expenses. In the medical pathway an assessor usually examines the worker and then issues a medical assessment certificate, which binds the parties unless it is appealed.
A member’s decision can be appealed to a presidential member of the Commission for an error of fact, of law, or in the exercise of a discretion, though an appeal is not a rehearing and the Commission publishes thresholds it has to clear. From there a party can appeal to the New South Wales Court of Appeal on the ground that the law was applied incorrectly.
The Commission says an application should not be lodged until all the relevant material is available, because it may not be possible to add documents later.
The time limits, and why no number appears here
There is more than one period and they are not the same. Making the claim has its own. Asking for a review, then applying to the Commission, have theirs. Appealing a medical assessment certificate has a much shorter one, running from the date the certificate was issued. Court proceedings for work injury damages are a separate limitation period again.
Which period binds you depends on the kind of claim, the injury, when it was notified, and what your document decided. Confirm the period that applies to you before you rely on it. Take it from your own document and the official sources below, and get advice while it is still running. Some periods can be extended and some cannot.
The scheme was also amended during 2026 and not all of it has commenced. The Commission records changes commencing on 27 March and 1 July 2026 and more set for October 2026, notes that its workers compensation information is being updated as the reforms are implemented, and states that it cannot advise on how the amendments apply to a particular case. Transitional provisions decide which version applies to your claim.
What usually happens
Find the document itself
Not the phone call or the text message about it. The written notice. Write down the date printed on it and the date it reached you.
Work out what was decided
Liability, weekly payments, medical expenses and work capacity are different decisions and they do not travel the same route. Read the letter for the decision and the reasons given.
Ask the insurer to review it, in writing
Say which decision the request is about and keep a copy. In some cases a review is required before a dispute can be lodged.
Get advice while the period is still running
Free legal information and referral is available through Legal Aid NSW and its LawAccess NSW service, and neither depends on anyone here. If a date on one of your documents is close, use them rather than wait.
Lodge with everything attached
Applications go through the Commission’s Pathway portal, with supporting documents filed as a single indexed and paginated bundle. Assemble the material first, because it may not be possible to add to it later.
Common questions
The insurer has not answered at all. Is there anything I can do?
Yes. The Commission lists a failure by the insurer to make a decision as one of the situations in which a worker can lodge an application. Waiting is not neutral, because other periods keep running while nothing happens.
Do I have to ask the insurer to review the decision first?
The Commission publishes that workers have the right to request an internal review, and that in some cases one is required before a dispute can be lodged. Check which applies to your decision rather than assume.
What will a dispute cost me?
No figure appears on this site. Costs in this scheme are regulated and are not arranged the way they are in ordinary litigation. The Commission publishes that most parties in workers compensation matters are entitled to government funding for legal assistance through the Independent Legal Assistance and Review Service, administered by the Independent Review Office. Ask for the costs position in writing before anything begins.
Can I run a dispute without a lawyer?
You can. The Commission accepts self-represented applicants and says it will help with the procedural side of an application, while stating that it cannot give legal advice. Free legal information and referral is available through Legal Aid NSW.
How long will it take?
Nobody can tell you at the start, and nothing here is a promise about timing. The Commission says it depends on the issues in dispute, how well the parties have prepared, whether they genuinely attempt to resolve it, and whether the decision is appealed.
Related
If a decision has arrived
Start with the letter and the date on it. A short summary of what has happened is enough to begin. Please do not send medical records or the full claim file before a conflict check.