Use the document to identify the current stage
Start with the most recent written document. Check who issued it, the decision or plan it records, the effective date, the evidence relied on and any response period. A Certificate of Capacity, rehabilitation report, section 78 notice and PIC certificate each serve a different purpose.
Claim stages in practical order
Not every claim passes through every stage. Treatment, weekly payments, work capacity and permanent impairment can also develop at different times.
1. Prepare, notify and lodge
Report the injury promptly, obtain medical care and keep the first account, Certificate of Capacity and wage records. A formal claim may be needed even where the insurer has begun provisional payments.
2. Insurer investigation
The insurer may obtain employer, witness, medical or factual material. Check the scope of any interview and correct a statement or report that does not accurately record the facts.
3. Treatment, capacity and recovery documents
Medical and workplace documents should agree about the injury, restrictions, treatment and actual duties. A plan cannot change a clinical restriction or replace an insurer decision.
4. Insurer decision and review
A section 78 notice, work capacity decision or payment calculation should state the outcome and reasons. Ordinary internal review is generally optional; the special relevant-conduct psychological pathway requires internal review first.
5. Personal Injury Commission dispute
The application must identify the real dispute, orders sought and supporting evidence. The Commission may use a legal, medical, expedited or damages pathway depending on the issue.
6. Permanent impairment and section 66
Once the condition is sufficiently stable, an approved assessor may provide a WPI opinion. A disputed medical assessment may lead to a binding PIC Medical Assessment Certificate.
7. Work injury damages
A damages claim has separate impairment, negligence, economic-loss and pre-filing requirements. Unresolved claims ordinarily proceed to PIC mediation before court proceedings are considered.
Which PIC pathway may apply?
| Pathway | When it may be used | Usual procedural result |
|---|---|---|
| Legal dispute | Liability, weekly payments, treatment, work capacity or another legal entitlement issue. | A Member may hold a preliminary conference, attempt conciliation and determine unresolved issues by arbitration. |
| Medical dispute | A medical question that the legislation permits PIC to refer, including permanent impairment. | An independent Medical Assessor issues a Medical Assessment Certificate on the referred medical questions. |
| Expedited assessment | An eligible urgent or interim dispute where the legislation and PIC procedure permit expedited handling. | The available interim direction and procedure depend on the dispute; it does not replace every final determination. |
| Work injury damages | A properly particularised economic-loss damages claim after the statutory pre-filing requirements. | PIC mediation seeks agreement. If unresolved and the preconditions are met, court proceedings may be considered. |
Procedural documents
Open the guide for the document you have received. Each guide explains who prepares it, what to check, evidence to keep and what may happen next.
Medical and recovery
- Certificate of CapacityDiagnosis, certified period, capacity and restrictions.
- Injury management planInsurer actions, recovery goals and review dates.
- Recovery-at-work planActual duties, hours, supports and escalation.
- Vocational assessmentSkills, restrictions, realistic jobs and earnings.
Decisions and disputes
- Section 78 noticeDecision, reasons, evidence and review options.
- Internal review outcomeWhat was reconsidered and whether the reasons changed.
- Medical Assessment CertificateBinding medical findings and limited challenge pathways.
Impairment and damages
- Permanent impairment reportMMI, assessment method, deductions and final WPI.
- Pre-filing statementNegligence, causation, economic loss and mediation.
Keep one claim chronology
- All insurer decisions and envelopes or emails showing when they were received.
- Certificates, clinical reports, referrals, treatment requests and approvals or refusals.
- Wage records, rosters, duties, recovery plans and records of actual work performed.
- PIC applications, replies, directions, admitted documents, certificates and settlement communications.
- A dated note of calls, meetings, missing actions and documents sent.
Common questions
Does every claim go to PIC?
No. Many claims are accepted or resolved with the insurer. PIC is used where a dispute requiring Commission determination remains.
Is an internal review always required?
No for most ordinary disputes. It is mandatory for the post-1 July 2026 relevant-conduct primary psychological injury pathway before PIC or IRC proceedings.
Does a rehabilitation plan decide my weekly payments?
No. It may provide evidence, but a payment change requires the applicable insurer decision and notice process.
Can one deadline apply to every document?
No. Review, PIC, medical appeal, damages and payment-effective dates use different rules. Check the document and obtain advice promptly.
Unsure which stage or document controls the next step?
Send the latest decision or report and a short chronology. We can assess the workers compensation dispute and whether an ILARS application may be available, subject to eligibility, merits and IRO approval.
Legal service provider
NSW workers compensation help from Stephen Young Lawyers
NSW Work Injury Claim is the workers compensation service of Stephen Young Lawyers. Stephen Young Lawyers provides the legal service. Stephen Young Lawyers.
Stephen Young Lawyers was established in 2012. The firm is led by Stephen Young, Principal Solicitor and Accredited Specialist in Personal Injury Law.
Workers across New South Wales can arrange telephone or video appointments. In-person appointments can be arranged at the Sydney office when appropriate.
NSW Work Injury Claim enquiries: (02) 7233 3661
- Content publisher:
- NSW Work Injury Claim
- Published:
- Last legally reviewed:
Key legal sources
- Workers Compensation Act 1987 (NSW)
- SIRA workers compensation
- IRO legal assistance for injured workers
- Personal Injury Commission
- SIRA Workers Compensation Guidelines, 1 July 2026
- SIRA dispute resolution pathways
- PIC workers compensation legal pathways
- PIC workers compensation medical pathways
- Personal Injury Commission Rules 2021
- Workplace Injury Management and Workers Compensation Act 1998
This information is general in nature and is not legal advice. You should obtain advice about your own circumstances.
. This guide provides general information, not legal advice. The correct procedure and deadline depend on the decision, injury date and issues in dispute.