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Reporting an Injury and Making a Claim for Workers Compensation

A worker seeking to make a claim for workers compensation must notify their employer of a work-related injury or illness as soon as possible after it occurs.

When notifying the employer, the worker should include the following details:

  • The date and time of the injury/illness, or the period over which the injury/illness arose
  • A description of how the injury/illness happened
  • A description of the injury/illness (e.g. a broken arm)

The employer is obliged to notify its workers compensation insurer within 48 hours of it receiving notification of a work-related injury/illness.

The workers compensation insurer is then obliged to write to the worker within seven (7) days of it receiving notification of a work-related injury/illness.

A worker who believes that their employer has failed to notify its workers compensation insurer of a work-related injury/illness can contact WIRO for assistance.

The worker can also contact the insurer directly and report the work-related injury/illness. The following information should be provided:

  • The worker’s name and contact details
  • The employer’s business name and contact details
  • The treating doctor's name and contact details
  • The date and time of injury/illness, or the period over which the injury/illness arose
  • A description of the injury/illness and how it happened

WIRO also recommends that the worker should provide the insurer with a completed Claim Form and a Certificate of Capacity from the treating doctor.

Alternatively, a third party may report a work-related injury/illness to an insurer on behalf of a worker. That person must provide the following additional information to the insurer:

  • Their name
  • Their relationship to the worker
  • Their contact details (including a phone number and postal address).

Who is the Insurer?

Most employers in NSW are required to have workers compensation insurance and obtain insurance through Icare, a government-owned insurer.

Private Sector Employers

Icare manages claims in-house. It also engages other insurers to manage claims on its behalf. Icare’s agents for claims made by workers in the private sector are currently:

  • Employers Mutual NSW Limited;
  • Allianz Australia Worker’s Compensation (NSW) Limited; and
  • GIO General Limited

Workers who are employed in the private sector, whose employers are insured by Icare, can lodge a claim directly through the Icare portal:

https://portal.icare.nsw.gov.au/lodgement/preliminary-info/

Public Sector Claims

Most employers within the public sector (NSW Government Agencies) are insured with the Treasury Managed Fund (also known as Insurance for NSW).

This fund is administered by the State Insurance Corporation, which is managed by Icare. As with private sector claims, iCare engages other insurers to manage these claims on its behalf and its current managers are:

  • Allianz Australia Insurance Limited
  • Employers Mutual Limited
  • QBE Insurance (Australia) Limited.

For more information, contact Icare on 13 44 22 or visit www.icare.nsw.gov.au.  

If further assistance is required, please contact WIRO.

Self-Insurers and Specialised Insurers

Some employers hold a licence to manage their own workers compensation claims. They are known as “Self-Insurers”.

Some employers take out workers compensation insurance with an insurer whose licence permits them to manage workers compensation claims within a specific industry. These insurers are known as “Specialised Insurers”.

For a list of Self-Insurers and Specialised Insurers, please visit:

https://www.sira.nsw.gov.au/insurance-coverage/workers-compensation-insurance/how-to-get-workers-compensation-insurance

Alternatively, if further assistance is required, please contact WIRO.

Claims against uninsured employers

A worker may still claim workers compensation if their employer does not hold current insurance.

These claims are managed by Icare with the assistance of EML (its claims partner). They can be contacted on 13 77 22.

EML may conduct investigations to help determine liability and/or seek further information that it requires to enable it to determine:

  • The name of the employer
  • Whether the employer was uninsured at the date of the injury/illness
  • Whether or not the definition of “worker” in the legislation is satisfied
  • Whether the injury/illness that is the subject of the claim occurred while the worker was working for the nominated employer?
  • If yes, whether that employment was a substantial contributing factor to the injury/illness.

EML may arrange to have the worker independently examined by a doctor of its own choosing and/or conduct a factual investigation before determining liability for the claim.

If further assistance is required, please contact WIRO.

The insurer’s response to claims

The insurer must notify a worker (or their representative) whether it will commence payments of compensation under provisional liability within seven (7) days of receiving notification of a work-related injury/illness,.

A worker who does not understand the insurer’s response may either contact it directly or contact WIRO for assistance.

The insurer may refuse to commence payments of compensation under provisional liability where a specified “reasonable excuse” exists. In that event, it must notify the worker of both the “reasonable excuse” and the action that the worker must take to resolve this and it will also request the worker to submit a completed claim form.

For example, the insurer may notify the worker that it has insufficient information about the claim and specify what further information it requires to enable it to determine liability. It must then determine liability within 21 days of receiving that further information.

If further assistance is required, please contact WIRO.

Time limits for claiming workers compensation

A claim for workers compensation should be made as soon as possible after the injury/illness occurs and the legislation provides that a claim should be made within six (6) months of the date of injury/illness (or in the case of a death - within six (6) months of the date of death).

However, that time limit may be extended in some circumstances. For example:

  • A claim can be made up to three years after the injury/illness occurred if the worker has a reasonable excuse for not making it within six (6) months. For example: absence from NSW, ignorance or mistake.
  • A claim may be made more than three (3) years after the accident if it relates to an injury/illness that resulted in either the death or serious and permanent impairment of a worker and there is a reasonable excuse for the delay. For example: absence from the state, ignorance or mistake.
  • A claim can be made more than three (3) years after the accident/illness if this is approved by the State Insurance Regulatory Authority (SIRA).

If further assistance is required, please contact WIRO.