Practical review
What to check in this situation
- Record who was told, when notice was given and how the injury or gradual condition was described.
- Confirm the insurer, claim number, benefits claimed and whether any information is said to be missing.
- Separate physical injury, primary psychological injury and psychological symptoms secondary to a physical injury.
Records that may help
Keep the incident record, first medical history, Certificate of Capacity, wage records, roster, claim receipt and every insurer notice.
Next procedural step
If liability or a benefit is disputed, answer the stated reason rather than lodging the same material repeatedly.
Overview
A claim can start before a formal claim form is required
Start by telling the employer about the injury and making sure the insurer receives enough information to identify the worker, employer and injury. A Certificate of Capacity may then support incapacity and treatment. A formal claim form is useful and is mandatory in some cases, but the current SIRA Guidelines do not require one for every ordinary claim.
Keep written proof even where a report was first made by phone. Dates matter when checking provisional payments, a reasonable-excuse notice, a formal liability decision or the general six-month claim period. The broader NSW workers compensation guide explains the main benefits and dispute types that may follow.
Notice, initial notification and a formal claim are different steps
Notice to the employer
Give notice as soon as possible. It identifies the worker, cause and date of injury. An injury-register entry made promptly is sufficient notice.
Initial notification to the insurer
This starts the ordinary provisional-liability timetable if the information required by the Guidelines has been supplied. It may be verbal or written.
Formal claim
This supplies the claim information required by the Guidelines. A claim form is not mandatory in every ordinary case, although it may be required in the situations described below.
Claim steps
- 1
Tell the employer about the injury
Give notice as soon as possible. State who was injured, when it happened and the cause in ordinary language. Notice may be oral or written, but a dated written record and an entry in the Register of Injuries are easier to prove later.
- 2
Make sure the insurer receives an initial notification
An initial notification can be made verbally or in writing by the worker, employer or someone acting for either of them. It needs enough information to identify the worker, employer, injury, notifier and any known treating doctor.
- 3
Obtain medical evidence where it is needed
A SIRA Certificate of Capacity can record the diagnosis, treatment, current work capacity and practical restrictions. It is important evidence for weekly payments, but it is not accurate to describe it as the document that creates every claim or entitlement.
- 4
Complete a claim form if the rules or insurer require one
A claim form may be submitted at any time, but the current SIRA Guidelines do not require one for every ordinary claim. A form is required in specified circumstances, including certain unresolved reasonable-excuse cases, some claims beyond provisional limits, and relevant-conduct primary psychological injury claims.
- 5
Check each written insurer response
Keep provisional-payment notices, reasonable-excuse notices, wage calculations, treatment decisions and any section 78 notice. Different decisions have different legal effects and response options.
When a claim form is required
- A reasonable-excuse notice remains relevant and the worker seeks weekly payments.
- Compensation is likely to continue beyond provisional limits and the insurer says it lacks enough information to determine ongoing liability.
- The claim is a relevant injury: a primary psychological injury allegedly caused by bullying, sexual harassment, racial harassment or excessive work demands.
The insurer can waive the form requirement if it has enough information to accept liability. An incomplete ordinary claim must be identified in writing within three business days under the Guidelines.
Evidence worth keeping
- Incident report, injury-register entry, photographs, witness details and relevant messages.
- Certificate of Capacity, clinical notes, referrals and treatment requests.
- Payslips, rosters, overtime, allowances and evidence of other employment.
- Claim number, proof of delivery and every insurer notice or decision.
- For gradual injuries, a chronology of duties, workload, symptoms and reports made over time.
Key timing rules
| Rule | What it means |
|---|---|
| Report as soon as possible | Section 254 requires notice to the employer as soon as possible. Statutory exceptions can apply, but delay can make the facts harder to prove. |
| Seven calendar days | For an ordinary injury, provisional weekly payments are to start after valid initial notification unless liability is determined or a Guidelines-based reasonable excuse is issued. The excuse is limited to weekly payments, not provisional medical payments. |
| Up to 12 weeks and $10,000 | Ordinary provisional weekly payments may run for up to 12 weeks. The insurer may provisionally accept up to $10,000 in medical expenses. Provisional acceptance is not an admission of liability. |
| 21-day formal-claim rule | A formal weekly-payment claim is ordinarily determined within 21 days, but provisional acceptance can extend the determination period. Do not apply the number without checking the notices and dates. |
| Six-month claim period | Section 261 generally requires a claim within six months. The Act contains exceptions, including later awareness and some delays caused by ignorance, mistake, absence from NSW or other reasonable cause. |
Relevant-conduct psychological claims use a separate pathway
For a primary psychological injury notified after the 1 July 2026 reforms and allegedly caused by bullying, sexual harassment, racial harassment or excessive work demands, the ordinary initial-notification and provisional-liability parts of the Guidelines do not apply in the same way. A completed claim and specified evidence are required, and the insurer generally has a 42-day determination period. Read the provisional liability guide before relying on the ordinary seven-day rule.
If the claim is delayed or disputed
Identify the document actually issued. A reasonable-excuse notice, treatment refusal, work capacity decision and section 78 liability notice are not interchangeable. Ask for the reason in writing, preserve the complete notice and answer the specific issue with medical, factual or wage evidence.
See the claim denial guide, section 78 notice guide and Personal Injury Commission pathway. ILARS funding may be available for eligible disputes, subject to an approved lawyer obtaining a grant. Funding is not automatic.
Related claim guides
Common questions
How do I start a workers compensation claim in NSW?
Tell the employer about the injury as soon as possible, make sure the insurer receives the required initial notification information, and obtain medical evidence if the injury affects work capacity or requires treatment. Keep proof of what was reported and sent.
Do I always need a workers compensation claim form?
No. Under the SIRA Workers Compensation Guidelines applying from 1 July 2026, a claim form is not required for every ordinary claim. It is required in specified situations, and an insurer may also waive a form where it has enough information to accept liability.
What is a SIRA Certificate of Capacity used for?
It records medical information about the injury, treatment, work capacity and restrictions. It can be necessary to support provisional weekly payments and ongoing incapacity, but the certificate does not by itself decide liability.
What does the seven-day provisional rule mean?
For an ordinary claim, provisional weekly payments are to start within seven calendar days after a valid initial notification unless the insurer determines liability or issues a reasonable excuse allowed by the Guidelines. A reasonable excuse applies to provisional weekly payments, not provisional medical payments.
Does the insurer always have only 21 days to make a final decision?
No. A formal weekly-payment claim is ordinarily determined within 21 days, but the Act extends that period where provisional liability has been accepted. The relevant date and type of notice must be checked before treating 21 days as a final deadline.
How long do I have to make a claim?
Section 261 of the 1998 Act generally requires a claim within six months after the injury, accident or death. The Act contains exceptions involving matters such as ignorance, mistake, absence from NSW, other reasonable cause, serious and permanent disablement, death and later awareness of injury. Late claims need individual advice.
Are primary psychological injury claims handled in the same way?
Not always. A post-1 July 2026 primary psychological injury allegedly caused by bullying, sexual harassment, racial harassment or excessive work demands is a relevant injury with a separate completed-claim and decision pathway. Other primary psychological injuries also have specific information requirements.
What if the employer does not notify the insurer?
Ask for the insurer name, claim reference and date of notification in writing. If the employer does not provide them, the worker or a representative can contact the insurer directly once it is identified. If the employer is uninsured, the SIRA and Nominal Insurer pathway may apply.
Last reviewed 20 July 2026. This information is general in nature and is not legal advice. Notice, time limits, injury classification, medical evidence and insurer obligations depend on the facts and the law applying to the claim.