Disputes

When the insurer says the scheme does not cover your injury

A liability dispute is an argument about whether your injury is covered at all, rather than about how much is paid. This page sets out what is in issue in that argument and where it 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

An insurer disputes liability when it says the scheme does not cover your injury: that you were not a worker, that there was no injury, that it did not happen at work, or that work did not contribute to it in the way the legislation requires. That is a different argument from one about the amount of a weekly payment or about a single treatment approval, and it usually decides everything else.

If a letter declining your claim has arrived, it is a decision rather than the end of the matter. The insurer can usually be asked to look at it again, and a dispute about it is decided by the Personal Injury Commission of New South Wales. If what you want first is the shape of the whole claim in order, start with how the scheme works.

What a liability dispute is about

Workers compensation is a statutory scheme, so a set of threshold questions has to be answered before any part of it applies to you. A liability dispute is an argument about one or more of those questions rather than about the size of an entitlement.

That is why a declined claim feels different from a reduced payment. A dispute about weekly payments or about a single treatment approval assumes the claim is covered and argues about the extent of it. A liability dispute goes to whether the claim is covered at all, so it carries weekly payments, medical and treatment expenses and everything downstream with it.

Liability can also be disputed in part. An insurer may accept an injury to one part of the body and decline another, or accept that something happened and dispute that the condition you have now came from it. Read what the insurer has accepted as closely as what it has declined, because the two are often in the same letter.

What is actually in issue

The Personal Injury Commission publishes the kinds of questions a legal dispute in its workers compensation division decides. In a liability argument it is usually one or more of these.

Whether the injured person was a worker. Contracting, labour hire and some casual arrangements can put this in issue before anything else is reached.
Whether an injury has occurred, and which body parts were injured.
Whether the injury happened at work.
Whether work was a substantial contributing factor to the injury. That is the Commission's wording. It tends to matter most where a condition built up over time, or where there is a history of the same complaint before the work in question.
Whether medical treatment is reasonably necessary, and the amount of compensation payable, which often ride alongside a liability argument rather than waiting until it is decided.

An insurer that has made no decision at all is also something you can take to the Commission. Waiting is not neutral, because other periods keep running while nothing happens.

Psychological injury, and the 2025 and 2026 amendments

The scheme was amended by the Workers Compensation Legislation Amendment Act 2025 and the Workers Compensation Legislation Amendment (Reform and Modernisation) Act 2026. The Commission publishes that those Acts changed injury assessment, claims management, available entitlements and how disputes are decided, and that there are significant changes to the eligibility for entitlements for primary psychological injuries notified after 1 July 2026.

The reform has been commencing in stages. The Commission records amendments to the Personal Injury Commission Act 2020 commencing on 27 March 2026, the Workers Compensation Legislation Amendment Regulation 2026 published on 26 June 2026 and commencing on 1 July 2026, and further changes set to commence in October. Its workers compensation pages carry a standing notice that their content may change as the reforms are implemented.

The practical consequence is that when an injury was notified can decide which version of the rules applies to it. If your claim involves a psychological injury, do not assume that anything written before your claim, including this page, describes the law that governs it.

Start with the document and the date on it

The insurer’s decision is a written document. Find it, and write down the date printed on it as well as the date it reached you. Periods in this scheme run from documents, and the first thing anyone helping you will ask for is the letter rather than an account of the phone call about it.

Then read it for what it decides and for the reasons given. A notice written in routine language can still decline a claim, and the reasons tell you what the argument will turn on. In liability disputes that is usually what was reported, to whom and when, and what the treating doctors recorded at the beginning. The guides on notifying an injury at work and on certificates of capacity deal with those two documents in detail, and when a decision goes against you covers the procedure around any insurer decision.

Asking the insurer to review its own decision

The Commission publishes that a worker may ask the insurer to review its decision, and that in some cases an internal review from the insurer is required before a dispute can be lodged. Which applies depends on what was decided, so check it rather than assume it. A claim also has to have been made on the insurer before any dispute can be lodged.

An internal review is the insurer looking at its own decision again. The reviewer is not independent of the insurer and it is not a hearing, but it is often the quickest route where a report was never read or a document never arrived. Put the request in writing, say which decision it is about, keep a copy, and keep watching the other dates, because a review does not stop them running.

Where a liability dispute is decided

Workers compensation disputes go to the Personal Injury Commission rather than to a court in the first instance. Applications are lodged through the Commission’s online Pathway Portal, and the Commission then assigns the dispute to a pathway, which decides how it is run and who decides it.

Legal disputes are where most liability arguments are resolved. The Commission holds a preliminary conference, usually online. If that does not resolve it, there is a conciliation conference, and if there is still no agreement, an arbitration hearing at which a member makes a binding decision.
Expedited assessments are a faster route for some disputes about weekly compensation and medical expenses, for a disputed work capacity decision, and where a worker and employer cannot agree on an injury management plan or on aspects of the worker's return to work. Eligibility is limited by how long the incapacity has run and how much is claimed.
Medical disputes are assessed by an independent medical specialist appointed by the Commission, who examines the worker and issues a medical assessment certificate. The Commission publishes that an assessor's assessment of the degree of permanent impairment is final and binding on the parties, subject to appeal.
Damages disputes are the work injury damages route, where the Commission publishes that all parties must participate in mediation at the Commission, with limited exceptions, before the matter goes to court.

The Commission says it will assist with the procedural aspects of an application, and that it cannot provide legal advice. Those are two different things.

The time limits are real, and no number appears here

There is more than one period in a liability dispute and they are not the same length. Making the claim has its own. Asking for a review and then applying to the Commission have theirs. Appealing a medical assessment certificate has a much shorter one that 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, the injury, when it was notified and what your document decided. Some can be extended and some cannot. Confirm the period that applies to you before you rely on it. Take it from your own document and from the official sources listed below, and get advice while the period is still running rather than after it has closed.

This is why no day count is published anywhere on this site. The periods are set by legislation amended through 2025 and 2026 with parts of it still commencing, and a figure that is right for one claim can be wrong for the next.

Help that does not depend on this site

A liability dispute can be run without a lawyer, and many are. The Commission accepts self-represented applicants and assists with the procedural side of an application. There is also funded and free help available that has nothing to do with this page.

Funded legal assistance. 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, which is administered by the Independent Review Office.
Complaints about an insurer. Legal Aid NSW describes the Independent Review Office as an independent body that deals with complaints by injured workers against insurers, including complaints about denials of liability and about delays in determining claims.
Free legal information and referral. LawAccess NSW is a free government telephone service that provides legal information and referrals and, in some cases, advice. Legal Aid NSW publishes its own information on workers compensation.

If you would rather not work it out alone, tell us what has happened and when the letter reached you. A short summary is enough to begin. Please do not send medical records before a conflict check.