Overview
How this affects your claim in practice
There is no universal "first 14 days" timetable for every NSW work capacity decision. The important dates are the notice date, the notice period and effective date stated in the insurer decision, and any PIC filing requirements. The current 14-day rule on SIRA's review page concerns the insurer's response after an optional review request. A worker may instead proceed directly to PIC.
- Start with the complete notice and identify the exact section 43 decision.
- Record the stated notice period and the date payments will change.
- Separate section 43 capacity, suitable-employment and current-earnings issues from any PIAWE decision.
- An insurer review is optional; it is not a mandatory section 44 step.
- A PIC application before the notice period expires may temporarily stay the decision.
- Match the current certificate of capacity and medical restrictions to each disputed duty, hour, travel or attendance assumption.
Read the notice before building the response
- What decision has been made under section 43?
- What medical, rehabilitation, vocational or wage evidence is listed?
- What weekly-payment amount is calculated before and after the decision?
- What notice period and effective date are stated?
- Does the notice mix a work capacity decision with a liability or medical dispute?
- Does it explain the optional insurer review and PIC options accurately?
A response aimed at the wrong issue can waste the notice period. For example, a medical certificate may address hours but not correct a separate PIAWE decision.
A safer date-based workflow
Use the dates in the actual notice rather than an invented fixed countdown
| Stage | Action | Why it matters |
|---|---|---|
| On receipt | Save the complete notice and proof of receipt; record the notice period and effective date. | The possibility of a PIC stay can depend on filing before the notice period expires. |
| Early evidence review | Match each insurer finding to the document needed to answer it. | Capacity, suitable work and current earnings are section 43 issues; PIAWE is a separate decision after 1 July 2026. |
| If seeking insurer review | Explain the alleged errors and provide relevant additional information. | SIRA says the insurer must respond within 14 days after receiving the optional request. |
| If applying to PIC | Use the correct dispute pathway and lodge the required material. | A worker may go directly to PIC; insurer review is not a prerequisite. |
| Before payment change | Confirm filing, stay position and immediate budget or treatment consequences. | A complaint or draft submission does not necessarily suspend the decision. |
Evidence by disputed issue
| Disputed issue | Evidence to examine |
|---|---|
| Current capacity | Certificates, treating reports, function across a full week, work attempts and medication effects. |
| Suitable employment | Qualifications, experience, restrictions, actual duties, location, travel and labour-market evidence. |
| Ability to earn | Hours, realistic wage rates, job availability and sustainable attendance. |
| Current weekly earnings | Post-injury payslips, actual gross earnings, suitable-employment assumptions and the calculation worksheet. |
| PIAWE decision | Pre-injury payroll, overtime, allowances, concurrent employment, earning period and the PIAWE worksheet. |
| Risk of further injury | A specific medical opinion connecting the proposed employment to the claimed risk. |
Optional insurer review or direct PIC
The worker does not have to follow an old section 44 internal-review ladder. SIRA states that the worker can ask the insurer for an optional review or proceed directly to PIC. If an insurer review is requested, someone other than the original decision-maker conducts it.
The appropriate choice depends on the time remaining under the notice, the seriousness of the payment change, whether decisive new evidence is available and whether the insurer reasons reveal an issue requiring independent determination.
Do not overlook the possible PIC stay
SIRA says a PIC review may temporarily stay the insurer decision if the application is lodged before the notice period in the decision expires. This may allow weekly payments to continue during the review.
The stay is not described as arising merely because the worker requested insurer review, contacted IRO or gathered evidence. Confirm the actual filing and notice position promptly.
Common errors to avoid
- Treating 14 days as the worker's universal legal deadline.
- Calling the optional review a current section 44 internal review.
- Waiting for insurer review without checking the payment-change date.
- Providing only a diagnosis when the dispute concerns sustainable hours or earning ability.
- Using generic labour-market material without testing the worker's restrictions and skills.
- Assuming a liability or medical dispute follows the work capacity review route.
Official sources
Sources are listed for transparency. This guide is general information only and is not legal advice.
Frequently asked questions
Do I have only 14 days to challenge a work capacity decision?
Not as a universal rule. SIRA's 14-day period is the insurer's response time after receiving an optional review request. Check the notice period, effective date and applicable PIC requirements in your case.
Can I apply directly to PIC?
Yes. SIRA says a worker may request an optional insurer review or proceed directly to PIC.
What should I preserve first?
Preserve the complete notice, proof of receipt, payment calculation, relied-on reports, current certificates, job material and wage records.
Will an optional insurer review stop the payment change?
Do not assume so. SIRA specifically identifies a possible stay where a PIC application is lodged before the notice period expires.
What if the decision also denies liability?
Section 43 excludes a liability dispute from the definition of a work capacity decision. The notice may contain more than one issue, and the correct dispute route should be identified for each.
Need help applying this to a live claim?
If an insurer has issued a notice, scheduled an assessment, reduced payments or refused treatment, consider obtaining advice about the documents and any applicable review steps.