Key References & Legislation
Start Your Claim Correctly
The NSW workers compensation scheme is designed to be self-managed, but insurers often use the strict procedural rules to delay or deny support. Following these steps ensures your rights are protected from day one.
The NSW Claim Journey
Immediate Notification (0–48 Hours)
Your first obligation is to notify your employer as soon as possible after an injury occurs. Under NSW law, an employer must be notified within 48 hours. Ensure the incident is recorded in the workplace Register of Injuries.
See Your Nominated Treating Doctor (NTD)
Consult your GP and explain clearly that the injury is work-related. They will issue a SIRA Certificate of Capacity. This is the single most important document for starting your weekly payments.
Lodging the Formal Claim
Your employer must notify their insurer within 48 hours of your report. However, you can (and should) lodge a claim form directly with the insurer if there is any delay. This triggers the 7-day rule for provisional liability.
Provisional Liability Period
The insurer usually has 7 days to start provisional weekly payments and medical expenses (up to $10,000) while they investigate. This is not an admission of full liability but provides immediate financial support.
The Formal Liability Decision
Within a set period (usually 21 days after a formal claim), the insurer must decide to either accept full liability, deny the claim (Section 78 notice), or request more time for medical investigations.
Critical Page Links
Deep-dive into specific areas of the claim process:
Provisional Liability Guide
What happens in the first 7 days.
Post-Injury Checklist
Steps to protect your health and claim.
Detailed Claim Process Guide
Legal timeline, evidence strategy, and decision points.
Weekly Payments Guide
PIAWE, step-downs, work capacity, and payment disputes.
Treatment Denial Guide
What to do if scans, rehab, surgery, or specialist care are refused early.
PIC Disputes Process
Where claim problems go when review and negotiation are not enough.
NSW Insurer Directory
Find the right insurer contact pathway quickly when employer reporting is delayed or unclear.
What usually goes wrong before a claim becomes a dispute
The claim-start phase looks administrative, but this is usually where the insurer builds the position it later relies on. If the first certificate is vague, wages are not checked, treatment stalls, or a “reasonable excuse” stretches too long, the problem can shift from a simple claim into a much harder dispute.
Provisional liability delay gets normalised
Workers often assume silence means the insurer is still processing paperwork. Sometimes it does. Sometimes it is the start of a liability fight. Compare the provisional liability guide with the section 78 notice guide if time keeps stretching without a clear answer.
Early wage mistakes become weekly-payment underpayments
If overtime, penalties, or second-job income are missed at the start, the insurer may keep using the wrong figure for months. The PIAWE calculation guide and recalculation pathway help workers spot that before arrears build up.
Treatment delay weakens the whole file
A delayed scan, specialist review, or surgery opinion is not just a medical inconvenience. It can also weaken the later evidence picture used for work capacity, impairment, and causation arguments. See the treatment denial guide and surgery denial guide.
Capacity framing starts before workers realise it
Once the insurer starts focusing on “suitable employment” and current work capacity, the claim is already moving toward a weekly-payments dispute. The work capacity guide explains how that shift affects payments and strategy.
Frequently Encountered Friction
While many claims proceed without issue, most injured workers will encounter one of the following "friction points" where the insurer disputes an entitlement:
- The "Reasonable Excuse": Insurers using minor paperwork gaps to delay provisional payments. See provisional liability rules for what can and cannot be delayed.
- Liability Denial (Section 78): Formally rejecting the claim based on medical or factual disputes. Read how to challenge a section 78 notice.
- PIAWE Calculation Errors: Under-calculating your pre-injury earnings by omitting overtime or bonuses. Use the PIAWE calculation guide to benchmark your entitlement.
Related claim-start and dispute guides
Claim Start FAQs
How long does an insurer have to start provisional payments in NSW?
In many cases, the insurer has 7 days from notification to commence provisional liability payments and treatment support unless a lawful reasonable excuse applies.
What if my claim is denied under section 78?
A section 78 notice can be challenged. You can seek an internal review, obtain stronger medical evidence, and escalate the dispute to the Personal Injury Commission where needed.
Can weekly payments be underpaid because of PIAWE errors?
Yes. Insurers sometimes exclude overtime, allowances, or shift penalties from pre-injury average weekly earnings (PIAWE). Reviewing payroll data early can materially increase weekly payments.
Has your claim been delayed?
If it has been more than 7 days since you reported your injury and you have not received a decision or payment, act quickly before delay turns into a formal dispute.