NSW Work Injury Claim

NSW Work Injury Claim

PIC Medical Assessment Certificates in NSW

A Medical Assessment Certificate (MAC) is issued by an independent Medical Assessor appointed by the Personal Injury Commission.

It answers the medical questions referred to the assessor and is binding on those questions unless it is changed through a valid appeal, reconsideration or correction process.

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What this document or stage means

Read the referral, findings, calculations and final certification together. A disagreement with the percentage is not itself an appeal ground, and the 28-day appeal period can run before every consequence of the certificate is obvious.

Who prepares or controls it

  • The PIC refers the medical dispute to an independent Medical Assessor.
  • The assessor reviews the admitted material, may examine the worker and issues the MAC with reasons.
  • The Commission sends the certificate to the parties. Neither the insurer’s doctor nor the worker’s doctor issues the MAC.

Why it is part of the claim

  • A permanent impairment, medical expenses, fitness or other statutory medical question was referred to a Medical Assessor.
  • The assessor has completed the assessment and certified the answer to the referred medical dispute.
  • The certificate may now affect section 66, weekly payments, treatment duration, commutation or work injury damages thresholds, depending on the question and current law.

What to check

Questions referred

Check the injuries, dates and medical questions the PIC asked the assessor to decide. The assessor should not determine a legal issue outside the referral.

Material considered

Confirm that the important admitted reports, imaging and operative records are identified. New material is tightly controlled after lodgment.

History and examination

Check material errors in the injury history, symptoms, treatment, measurements, neurological findings or validity observations.

Method and calculations

Trace the NSW or AMA method, deductions, conversions, combining and rounding. Identify a demonstrable arithmetic or table error precisely.

Certification and reasons

The final section states the certified outcome. Read it against the reasons and each referred injury rather than relying on a single headline percentage.

Mistakes or gaps to look for

  • An injury or body system in the referral is not addressed.
  • A material report or scan in the admitted bundle is overlooked or misdescribed.
  • Measurements, table references, conversion or Combined Values Chart arithmetic do not match the stated outcome.
  • The assessor decides legal causation or liability rather than the medical question referred.
  • The certificate is treated as non-binding merely because another doctor disagrees.

Evidence to keep

  • The PIC referral, application, reply and indexed document bundle.
  • Appointment notice and a contemporaneous note of the examination and measurements.
  • The complete MAC, reasons and date it was issued to the parties.
  • The reports or records said to have been omitted or misunderstood.
  • A draft appeal chronology identifying the statutory ground, error and material effect.

What happens next

  1. If no valid challenge is made, the certified medical outcome is binding for the referred statutory questions.
  2. A workers compensation medical appeal requires leave and one or more section 327(3) grounds. Incorrect criteria or demonstrable error appeals generally must be lodged within 28 days.
  3. A Form 19 reconsideration request should be made as soon as practicable and must explain why reconsideration, rather than appeal, is the proper course. It is not a way to avoid an expired appeal period.
  4. A correction process is limited to an obvious error and does not reopen the merits.

Timing and deadlines

  • The PIC medical appeal period is generally 28 days after the certificate is issued to the parties for an appeal based on incorrect criteria or demonstrable error, subject to the legislation and any extension available in special circumstances.
  • Different rules govern deterioration, additional information, further assessment and reconsideration. Act promptly rather than waiting for an insurer offer.
  • The respondent generally has 21 days after registration to reply to a medical application, but the MAC page begins after that earlier process has concluded.

When legal advice may be useful

  • Advice is useful immediately because the appeal ground, evidence and time limit must be identified precisely.
  • A lawyer can distinguish an appeal, reconsideration, correction, further assessment and a separate legal dispute, and assess whether ILARS funding may be available.

Illustrative example

Illustration: a possible calculation error

A MAC records two physical impairments and states the correct individual values, but the final percentage appears to be their simple total. The reasons do not show the Combined Values Chart sequence.

  • Reproduce the calculation using the applicable method.
  • Identify whether the difference changes the certified result.
  • Obtain advice before the 28-day period expires rather than asking the insurer informally.

Common questions

Is a Medical Assessment Certificate binding?

Yes, for the medical matters the legislation makes binding. It may be changed only through an available statutory appeal, reconsideration or correction process.

Can I appeal because my own doctor gave a higher WPI?

A different opinion alone is not enough. The appeal must rely on a statutory ground and explain a material error or qualifying new evidence.

How long do I have to appeal?

For incorrect criteria or demonstrable error, the ordinary period is 28 days after issue to the parties. Special-circumstances extensions are limited, so obtain advice immediately.

Is reconsideration the same as appeal?

No. PIC7 treats them as different processes. A reconsideration request should explain the identified error and why reconsideration is appropriate rather than appeal.

Need help checking a claim document?

Send the decision, report or plan with a short explanation of what has changed. We can assess the dispute and whether an ILARS funding application may be available, subject to eligibility, merits and IRO approval.

Request a free claim checkCall (02) 7233 3661

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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

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

Last legally reviewed: . This page provides general information about NSW workers compensation procedure. It is not legal advice, and the correct response may depend on the document, injury date and dispute.

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