The scheme

How the scheme works

What the New South Wales workers compensation scheme is, who does what in it, what it pays for, and where a disagreement with an insurer is decided.

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.

Last updated: 23 September 2026

If you have been hurt at work in New South Wales, what happens next is set by a statutory scheme rather than by your employer. This page describes that scheme in outline: which body does what, what each decision is called, what the scheme pays for, and how a dispute about a decision is dealt with.

Most of what follows is procedural. The scheme is easier to deal with once you can see its shape, and once you know which of your documents each period runs from.

What the scheme is

Workers compensation in New South Wales is a creature of statute. The two main Acts are the Workers Compensation Act 1987 (NSW), which sets out what compensation is payable, and the Workplace Injury Management and Workers Compensation Act 1998 (NSW), which deals with claims, injury management and how the system is run. What you are entitled to comes from those Acts and the instruments made under them, not from an agreement with your employer.

Compensation under the scheme is generally available without proving that anyone was at fault. That is the main difference between it and a damages claim, and it is why so much of the argument in workers compensation is about medical evidence, capacity and what the documents say rather than about blame.

Who your insurer is depends on the policy your employer holds. icare, which administers workers insurance in New South Wales, publishes that you can still make a claim even if your employer does not hold workers insurance, or if the insurer that issued the policy has been declared insolvent.

The insurer receives the claim, pays it, and makes the decisions on it in writing.
The State Insurance Regulatory Authority regulates the New South Wales workers compensation system and publishes the guidance insurers work to.
The Personal Injury Commission of New South Wales decides disputes. It describes itself as an independent statutory tribunal established by the Personal Injury Commission Act 2020, and workers compensation is one of its divisions.

The Commission is a tribunal, not a court. It publishes that it cannot give legal advice, although it will assist with the procedural side of an application.

What the scheme pays for

The Commission describes the entitlements that can be in dispute as weekly compensation, medical and related expenses compensation, lump sum compensation for permanent impairment, and payments in respect of the death of a worker.

Weekly payments, while you cannot work or can only work reduced hours.
Medical, hospital and related treatment expenses, including rehabilitation.
A lump sum for permanent impairment, once impairment can be assessed.
Payments in respect of the death of a worker.
Work injury damages, which is a separate claim against the employer and is dealt with further down this page.

None of this is automatic, and the parts of the scheme are staged. What is available in a particular claim depends on the injury, on the medical evidence, and on the decisions already made.

How a claim starts

A claim usually begins with telling your employer, who notifies the insurer. Tell them even if the injury seems minor and even if you do not intend to take time off, because the record made at the time tends to carry more weight later than an account given months afterwards.

Your nominated treating doctor then provides a certificate of capacity. icare describes it as the document that determines whether you are able to work, what types of duties you may be able to perform, and what kind of treatment you need. It is the hinge of most claims, and a certificate written in a hurry can follow a claim for years.

The insurer then makes decisions and puts them in writing: whether liability is accepted, what weekly payments are payable, and whether particular treatment is funded. There is more on the first steps in the guide to notifying an injury at work.

Keep the paperwork in one place from the beginning. Periods in this scheme run from documents.

Capacity, suitable duties and getting back to work

Returning to work is part of the scheme rather than something that happens after it. icare publishes that your employer is obligated by law to provide suitable work that matches your capacity and supports your recovery where possible, and that a claims manager may be assigned to coordinate the claim and stay in contact with you, your employer and your treating practitioner.

Capacity is also assessed by the insurer, and a work capacity decision is a decision like any other. If the insurer decides you can work more hours, or different duties, than you believe you can, that decision takes effect unless it is disputed. The Commission lists a disputed work capacity decision, and disagreements about injury management and returning to work, among the matters that go through its expedited pathway. In an injury management dispute it may first direct an independent injury management consultant to carry out a workplace assessment.

When the insurer decides something you disagree with

The first step is usually to ask the insurer to look again. The Commission publishes that a claim must first have been submitted with the insurer, and that in some cases an internal review by the insurer is required before a dispute can be lodged at all. An internal review is the insurer reconsidering its own decision, so the reviewer is not independent of it, but it is often the quickest route where a report was never read.

If the matter is still unresolved, an application is lodged with the Personal Injury Commission through its online Pathway Portal. Once the Commission has the application and the reply, it assigns the dispute to a pathway according to the type of claim, the issues in dispute and the compensation sought.

A worker can apply where the insurer has not accepted all or part of the claim, where the worker disagrees with the decision or with the amount payable, or where the insurer has made no decision at all. Waiting for an insurer that is not answering is not a neutral choice, because other periods keep running. There is more in the guide to when a decision goes against you, and on liability disputes.

Legal disputes, about entitlement to weekly payments, medical expenses, permanent impairment lump sums and death benefits. They start with a preliminary conference, usually online, then a conciliation conference and, failing agreement, an arbitration hearing the same day.
Medical disputes, mostly about the degree of permanent impairment. An independent assessor issues a medical assessment certificate, which the Commission publishes is final and binding on the parties, subject to appeal to a medical appeal panel.
Expedited assessments, a faster route for some weekly payments and medical expenses disputes, disputed work capacity decisions and injury management disputes, run by a senior lawyer or member who can issue an interim payment direction.
Damages disputes, the work injury damages route, where mediation at the Commission comes before any court proceedings.
Other disputes, a miscellaneous category.

Work injury damages is a separate claim

Work injury damages sits at the edge of the scheme. The Commission describes it as a modified common law damages claim in which the worker needs to establish that the injury resulted from the employer’s negligence. Unlike the rest of the scheme, fault is the question.

Two gates come first. The worker must have a degree of permanent impairment at or above the level the legislation sets, and must already have received the statutory lump sum entitlements for permanent impairment to which they are entitled. The threshold is a fixed figure in the legislation and it is not printed here, because the figure that matters is the one in force for your claim, read against your own assessment.

Mediation at the Commission is a compulsory step before court proceedings, with limited exceptions. The Commission publishes that the mediator does not decide the outcome and does not give advice. If the claim does not settle there, it goes to court. There is more on work injury damages.

Time limits, and why no number appears here

There is more than one period in this scheme and they are not the same as each other. Notifying the injury has one. Making the claim has another. Asking the insurer for a review, and then applying to the Commission, have theirs. Appealing a medical assessment certificate has a much shorter one, and it runs 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, on the injury, on when it was notified, and on what your document decided. Confirm the period that applies to you before you rely on it. Take it from the document you were given and from the official sources at the foot of this page, and get advice while the period is still running. Some periods can be extended and some cannot.

If a date on one of your documents is close, use the free services listed below rather than wait for anything else.

The scheme is being changed

The workers compensation legislation was amended across 2025 and 2026, and not all of it has commenced. The Personal Injury Commission records the Workers Compensation Legislation Amendment Act 2025 and the Workers Compensation Legislation Amendment (Reform and Modernisation) Act 2026, together with the Workers Compensation Legislation Amendment Regulation 2026, which was published on 26 June 2026. Some changes commenced on 27 March 2026, others on 1 July 2026, and further changes were set to commence in October 2026.

The Commission’s own workers compensation pages carry a notice that the information on them is being updated and may change as the reforms are implemented. Transitional provisions decide which version of the law applies to a particular claim, and that is a question to be answered against your dates and the amending Acts rather than assumed from the current text.

This page was written on 23 September 2026 against the sources listed below. Where it and an official source differ, the official source is right.

Help that does not depend on this site

Many workers compensation claims are dealt with directly with the insurer and never need a lawyer. Where a dispute does go to the Commission, it publishes that most parties are entitled to government funding for legal assistance through the Independent Legal Assistance and Review Service, which is administered by the Independent Review Office. The Independent Review Office is also the body that deals with complaints by injured workers about insurers.

LawAccess NSW is a free information service run by Legal Aid NSW, which provides legal information and referrals and, in some cases, advice. Legal Aid NSW gives free legal advice, and there are community legal centres across the state. None of those services depends on anyone here.

If you would rather have your documents looked at, you can tell us what has happened. A short summary is enough to begin. Please do not send medical records before a conflict check.