Practical review
What to check in this situation
- Reconcile the insurer authority, ordinary pay cycle, employer payslip and bank receipt week by week.
- Ask whether the issue is payment processing, reimbursement between insurer and employer, or a legal entitlement decision.
- Escalate an unresolved claims-handling delay to IRO without overlooking a separate formal dispute deadline.
Records that may help
Keep insurer acceptance and payment advice, payslips, bank statements, payroll emails, payment history, Certificates of Capacity and any formal notice or calculation.
Next procedural step
Send one written reconciliation request to payroll and the insurer, ask who will pay and when, and seek urgent review if a notice or continuing non-payment affects essential income.
What to check first
- Find the written notice and the date it says the reduction or cessation takes effect.
- Identify whether it concerns work capacity, liability, PIAWE, a statutory entitlement period, evidence, or a return-to-work obligation.
- Keep the notice, current Certificates of Capacity, wage records and every report the insurer says it relied on.
- Check the procedure before the effective date. A review request is optional in some pathways, and a timely PIC filing may matter.
Classify the insurer decision before responding
Section 78 of the 1998 Act is a notice provision. It requires notice when an insurer disputes liability or decides to discontinue or reduce weekly payments. It does not make every notice the same kind of decision. Section 79 also requires the notice to state the reasons and relevant issues in concise, understandable terms.
Administrative payment or payroll delay
The insurer may have authorised weekly payments but the employer payroll or insurer remittance has not arrived within the usual pay cycle. That is a payment-processing problem unless a separate legal decision has been made. Ask both parties who is responsible for payment, the authorised amount, the affected weeks and the payment date.
Work capacity decision
This can concern current work capacity, suitable employment, earning ability or another current section 43 category. The worker may request an optional insurer review or apply directly to PIC. For section 289B to apply, the dispute must be referred before the section 80 notice period expires; the stay operates from the time the President accepts the referral.
PIAWE decision
For a PIAWE decision made on or after 1 July 2026, PIAWE is not a section 43 work capacity decision. SIRA identifies an optional insurer review or a PIC dispute, and section 44BA provides the separate PIC pathway.
Liability dispute
The insurer may dispute all or part of the claim, including injury, causation, incapacity or another entitlement issue. A liability notice must identify the statutory provision relied on. Section 287A permits a worker to request insurer review before referring the dispute to PIC, and requires a decision within 14 days. That review is optional rather than a compulsory first step.
Statutory period or rate change
A payment can change when an entitlement period ends or a statutory limit applies. That is not automatically a work capacity reassessment. The underlying section, transitional rules, impairment status and claim history still need to be checked.
Certificate or return-to-work obligation issue
Missing capacity evidence and alleged failure to meet return-to-work obligations involve separate statutory provisions. SIRA states that an insurer may stop weekly payments within seven days after advising that a completed Certificate of Capacity is required. A section 48A return-to-work notice has its own written-notice, suspension and termination steps. Read the actual provision cited rather than treating either issue as a work capacity decision.
Section 80 notice periods
These periods apply under section 80 only after the worker has received weekly payments continuously for at least 12 weeks. They are notice periods, not general deadlines for the worker to complete every review or PIC step.
| Decision | Required notice | Important qualification |
|---|---|---|
| Reduction or cessation resulting from a work capacity reassessment | 3 months | The dispute must be referred before this period expires; the stay operates when the President accepts the referral. |
| Other decision after continuous payments of less than 1 year | 2 weeks | The classification and any separate dispute requirements still matter. |
| Other decision after continuous payments of 1 year or more | 6 weeks | A combined liability and cessation notice does not remove this requirement. |
| Change resulting only from a different statutory rate after an earlier entitlement period ends | Different rule | Section 80(1) does not apply, but notice must be given before the earlier period expires. |
Evidence should answer the stated reason
More documents are not always better. Start with the factual and legal issue identified in the notice, then collect material that addresses it directly.
Payment-processing delay
Insurer acceptance and payment authority, employer payslips, bank receipts, ordinary pay-cycle dates, payroll emails and a week-by-week reconciliation of authorised and received amounts.
Capacity and suitable employment
Current Certificates of Capacity, treating reports, job demands, rehabilitation reports, actual hours and earnings, and any factual errors in the insurer assessment.
PIAWE or current earnings
Payroll summaries, pay slips, rosters, bank records, employment agreements and records for each concurrent job. Particular overtime, allowance or non-monetary-benefit rules must be checked rather than assumed.
Liability or medical causation
The section 78 notice, contemporaneous clinical notes, incident records, work history and medical opinions addressing the insurer's actual causation or incapacity reasoning.
130- or 260-week issue
Payment history, current capacity, hours, earnings and permanent-impairment evidence relevant to the particular statutory pathway. Primary psychological injury now has separate post-1 July 2026 rules.
Illustrative example: authority exists but the payment is missing
The insurer confirms that weekly compensation remains authorised, but the employer pays ordinary worked hours only and no compensation top-up appears in the usual fortnightly payroll. No section 78 notice or work capacity decision has been issued.
The worker sends payroll and the insurer a table showing each authorised week, the expected pay-cycle date, gross wages received and the missing top-up. This treats the issue as payment processing while preserving the right to respond separately if the insurer later makes a formal decision. The example does not establish the amount payable or predict a recovery.
Dispute options are not one fixed sequence
- Separate missing payment from a formal decision. Ask whether weekly payments remain authorised and whether the problem sits with insurer remittance, employer payroll or a decision changing entitlement.
- Read the whole notice. Record the decision date, effective date, statutory provisions and evidence relied on.
- Confirm the decision type. Work capacity, PIAWE, liability and compliance disputes have different rules.
- Choose the procedure deliberately. An insurer review is optional for current work-capacity and PIAWE decisions; direct PIC access may be available. Other disputes must satisfy the applicable referral requirements.
- Check any stay before the notice expires. Section 289B is specific to a disputed work capacity decision. The referral must be made before the notice period expires, and the stay operates when the President accepts it.
- Ask about funding without assuming it. An IRO Approved Lawyer may apply for ILARS funding if the worker and issue meet the current Guidelines.
Frequently asked questions
What if the insurer approved payments but my employer has not paid me?
SIRA says accepted weekly payments may be made by the employer or insurer within the usual pay cycle. Contact payroll and the insurer in writing, request a week-by-week reconciliation and ask who will make the missing payment and when. Preserve any separate formal notice because its dispute pathway is different.
Why can weekly payments be reduced or stopped?
The reason may be a work capacity decision, a liability dispute, a PIAWE or current-earnings decision, the end of a statutory entitlement period, a missing Certificate of Capacity, a return-to-work obligation issue, retirement provisions, or another claim-specific rule. The written notice should identify the decision and its reasons.
How much notice must an insurer give?
Section 80 of the 1998 Act applies after at least 12 continuous weeks of weekly payments. A reduction or cessation resulting from a work capacity reassessment has a three-month notice period. In other cases, the period is generally two weeks if continuous payments have been received for less than one year, or six weeks if they have been received for one year or more. Different rules apply to an automatic change in the statutory payment rate after an entitlement period ends.
Must I ask the insurer to review a work capacity decision before going to PIC?
No. An insurer review is optional. A worker may request that review or apply directly to the Personal Injury Commission. If an optional review is requested, the insurer must decide it within 14 days. The correct procedural choice depends on the notice and evidence.
Can a PIC application keep weekly payments going?
For a disputed work capacity decision that reduces or stops weekly payments, the dispute must be referred to PIC before the section 80 notice period expires for section 289B to apply. The stay operates from the time the President accepts the referral. It does not automatically apply to every type of weekly-payment dispute.
Is a PIAWE decision still a work capacity decision?
For PIAWE decisions made on or after 1 July 2026, no. PIAWE is excluded from section 43 and has a separate PIC pathway under section 44BA. SIRA states that a worker may request an optional insurer review or lodge a PIAWE dispute with PIC.
Can ILARS fund legal assistance about stopped weekly payments?
It may. An IRO Approved Lawyer can assess whether the worker and issue meet the current ILARS Funding Guidelines and may apply for a grant. Funding is not automatic and depends on approval and the scope of the grant.
Have the notice and effective date checked
Send the insurer notice, current Certificates of Capacity and the reports or wage records the decision relies on. Legal assistance may be funded through ILARS for an eligible worker and issue, subject to an approved grant.
General information only, not legal advice. The applicable law can depend on the injury date, worker category, payment history and the precise insurer decision.
Related claim pathways
Other claims that may need to be considered
A work injury claim is often the first issue, but some facts can raise a separate insurance or injury pathway. These links are included only where the overlap may genuinely matter.
Long-term inability to return to work
If you are unlikely to return to suitable work long-term, you may also need to check whether TPD insurance through superannuation is available. TPD is separate from workers compensation.
My TPD ClaimsRelated weekly-payment and dispute guides
- NSW workers compensation claims and disputes
- Weekly payments overview
- Work capacity decision disputes
- Understanding a section 78 notice
- How PIAWE is calculated
- Requesting a PIAWE recalculation
- Part-time work and weekly-payment calculations
- Weekly payments after 130 weeks
- The 260-week limit
- Personal Injury Commission disputes
- Request a claim check