NSW Work Injury Claim

NSW Work Injury Claim

When should provisional liability and weekly payments begin?

For an ordinary NSW claim, the insurer generally must start provisional weekly payments within seven calendar days after receiving a compliant initial notification, issue a valid reasonable excuse within that period, or determine liability. Provisional acceptance is temporary and does not finally accept every injury or entitlement. A completed Certificate of Capacity and reliable earnings information remain important to payment calculation.

Do not apply that seven-day pathway mechanically to every post-1 July 2026 primary psychological claim. Claims involving bullying, sexual harassment, racial harassment or excessive work demands can use the separate relevant-conduct determination and interim-entitlement process. The notification date, injury classification, missing information and benefit claimed must be checked first.

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Illustrative editorial scene of a worker checking a provisional-liability notification beside capacity and wage records.

Practical review

What to check in this situation

  • Prove when the insurer received all information required for initial notification and identify any claimed wage loss.
  • Check whether the insurer commenced payments, determined liability or issued a recognised reasonable excuse in time.
  • Read the provisional notice for its duration, injury scope, PIAWE basis and medical-expense limit.

Records that may help

Keep the notification receipt, claim reference, Certificate of Capacity, payslips, employer details, reasonable-excuse notice, PIAWE advice and first payment remittance.

Next procedural step

Ask the insurer to state the current liability position and payment start date in writing; use an IRO complaint or obtain dispute advice if the response remains overdue.

Overview

Ordinary provisional liability at a glance

7 days

Ordinary provisional weekly payments generally start within seven calendar days after a valid initial notification, unless a Guidelines-based reasonable excuse applies or liability is determined.

Up to 12 weeks

The insurer may provisionally accept weekly-payment liability for a period of up to 12 weeks. This is not final acceptance.

Up to $10,000

The current Guidelines allow provisional acceptance of medical expenses up to $10,000 before a formal liability determination.

These figures describe the ordinary pathway. They do not apply in the same way to a relevant-conduct primary psychological injury claim.

For the wider entitlement and dispute framework, see our NSW workers compensation guide.

What counts as an initial notification?

The current Guidelines say an initial notification can be written or verbal and can come from the worker, employer or someone acting for either of them. It must contain enough identifying and injury information, including the worker and employer details, when and how the injury occurred, whether treatment is required, and whether the injury caused incapacity and loss of income.

Keep the date and method of notification. A claim number, email confirmation, incident report or call reference can help establish when the insurer received the information that triggered the ordinary provisional-liability process.

What a reasonable excuse can cover

A reasonable excuse can delay ordinary provisional weekly payments only if it is one of the excuses recognised by the Guidelines. The insurer must give written notice within seven days and explain the excuse, how a claim can be made, and how the issue can be resolved.

  • Insufficient medical information to establish an injury.
  • Information indicating the injured person may not be a worker.
  • The insurer cannot contact the worker after the attempts specified in the Guidelines.
  • The worker refuses access to information relevant to provisional liability.
  • Supported information strongly indicates the injury is not compensable.
  • The available information shows no incapacity or loss requiring weekly payments.
  • The injury was notified more than two months later, subject to the Guidelines qualification.

Suspicion, innuendo, anecdotes or unsupported information are not enough for the non-work-related excuse. A reasonable excuse is not itself a final section 78 denial. If the stated gap is fixed, the insurer should reconsider the provisional-payment position or determine liability.

Provisional medical expenses are a separate question

The Guidelines specify up to $10,000 for provisional medical expenses. They also state that a reasonable excuse applies to provisional weekly payments, not provisional medical payments. This does not mean every proposed treatment must be paid: the treatment and entitlement requirements still need to be met, and the insurer may make a separate liability or treatment decision.

If a particular consultation, scan, rehabilitation service or surgery is refused, ask for the written reason and use the treatment dispute guide to identify the evidence and forum relevant to that decision.

Different rules for relevant-conduct psychological claims

For a primary psychological injury allegedly caused by bullying, sexual harassment, racial harassment or excessive work demands and claimed under the relevant-conduct pathway, ordinary provisional liability and reasonable excuses do not apply. The worker must provide a completed claim with the required minimum information.

IssueRelevant-conduct pathway from 1 July 2026
Liability decisionThe insurer has 42 days after receiving the completed claim. If no decision is made in time, the claim is taken to be accepted.
Interim weekly paymentStarts as soon as practicable and no later than seven days after the completed claim. It is generally 75% of PIAWE, less current weekly earnings where applicable, subject to the statutory maximum.
Interim treatmentUp to $7,500 for medical or related treatment connected with the relevant injury during the determination period, subject to the statutory limits.
When interim entitlements ceaseGenerally 56 days after the claim, or 14 days after an earlier insurer decision disputing liability.
ReviewInsurer internal review is mandatory before the dispute can proceed to the PIC or IRC.

This distinction is important: a worker should not be told that a reasonable excuse or the ordinary 12-week provisional period governs a completed relevant-conduct claim.

Documents to keep

  • the incident notification, claim number and proof of when the insurer received it;
  • the certificate of capacity and later certificates;
  • claim forms, signed authorities and any incomplete-claim notice;
  • the insurer's provisional acceptance or reasonable excuse notice;
  • PIAWE calculations, payslips and payment records;
  • treatment requests, approvals, invoices and refusal notices; and
  • any later section 78 notice and the reports supplied with it.

A claim form is not required in every ordinary claim. Under the current Guidelines it is required in specified circumstances, including while a reasonable excuse remains relevant and weekly payments are sought, where compensation beyond provisional limits is likely and information is insufficient, and for a relevant-conduct injury. An insurer can waive the form in some ordinary cases if it has enough information to accept liability.

What happens before the provisional period ends?

Provisional acceptance gives the insurer more time to investigate while payments are made. It does not allow the insurer to leave the claim undecided indefinitely. A provisionally accepted weekly claim should be finally determined before the provisional period expires. The outcome may be full acceptance, another lawful payment decision, or a written section 78 notice disputing liability or an aspect of the claim.

If a decision is disputed, a worker may ask the insurer to review it before the matter is referred to the Personal Injury Commission. Under section 287A, the insurer must conduct a requested review and notify the worker within 14 days. That review is generally optional for the worker, except where the relevant-conduct psychological pathway makes internal review a required step.

Illustrative example

An ordinary physical-injury notification

A worker reports a lifting injury to the employer and insurer on a Monday and supplies a completed Certificate of Capacity showing wage loss. For the ordinary pathway, the insurer should start provisional weekly payments, issue a recognised reasonable excuse or determine liability within seven calendar days after receiving a compliant initial notification. The insurer later makes the full liability decision before the provisional period ends.

This example illustrates timing only. It does not prove that the notification was complete, that a reasonable excuse was unavailable, that the claim will be accepted or what amount should be paid.

Frequently asked questions

What is provisional liability in NSW workers compensation?

It is temporary acceptance that lets an insurer start ordinary weekly payments or pay medical expenses while it investigates liability. Provisional acceptance is not an admission that the claim is finally accepted.

When should ordinary provisional weekly payments start?

For a claim covered by the ordinary provisional-liability process, section 267 requires payments to start within seven days after initial notification unless the insurer has a reasonable excuse recognised by the current Workers Compensation Guidelines or determines liability.

How long can provisional weekly payments continue?

The insurer may provisionally accept weekly-payment liability for up to 12 weeks, having regard to the nature of the injury and period of incapacity. The claim should be finally determined before the provisional period ends.

How much provisional medical treatment can be paid?

The Workers Compensation Guidelines commencing 1 July 2026 specify up to $10,000 in provisional medical expenses before a formal liability determination. Treatment must still satisfy the applicable workers compensation requirements.

Can a reasonable excuse stop provisional medical payments?

The current Guidelines state that a reasonable excuse applies to provisional weekly payments, not provisional medical payments. A medical-expense claim can still require a separate liability or treatment decision.

Do the same rules apply to every primary psychological injury?

No. A primary psychological injury caused by alleged bullying, sexual harassment, racial harassment or excessive work demands and claimed under the relevant-conduct pathway uses interim entitlements rather than ordinary provisional liability. A completed claim is required and different payment and decision periods apply.

Related claim and dispute guides

Unsure which early-payment process applies?

Send the notification date, injury type, claim form and insurer notice. We can help identify whether the issue is ordinary provisional liability, a relevant-conduct interim entitlement, a treatment decision or a section 78 dispute.

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This information is general in nature and is not legal advice. You should obtain advice about your own circumstances.