How to Lodge a Workers Compensation Claim in NSW

Lodging a workers compensation claim in New South Wales is not complicated, but it is time sensitive. Most of the problems we see at Actevate are not caused by complex injuries. They are caused by a delay in the first week: an injury reported late, an insurer notified after the 48 hour window, a Certificate of Capacity that says "stress" instead of a diagnosis, or a worker who was never told what happens next.

Those small delays compound. A claim that starts cleanly is more likely to be accepted, more likely to result in a return to work, and significantly cheaper for the employer. A claim that starts badly can sit in dispute for months while the worker loses income and confidence, and the employer wears the premium impact for years.

This guide walks through the entire process as it operates in NSW in 2026, including the reforms that commenced on 1 July 2026. It covers both sides: what an injured worker needs to do, and what an employer is legally required to do at the same time.

Before you start: three things that decide how a claim goes

Across nearly two decades of managing claims for Australian employers, the same three factors separate a smooth claim from a difficult one.

• Speed. The first 48 hours set the tone. Early notification triggers early intervention, and early intervention is the single strongest predictor of a fast, durable return to work.
• Accuracy. A vague injury description or a certificate without a proper diagnosis forces the insurer to investigate, and investigation means delay. Specific facts get specific decisions.
• Contact. Workers who stay connected to their workplace recover faster. The longer someone is away, the lower the probability they ever return.

Info: Almost every difficult claim we are asked to rescue can be traced back to something that happened, or did not happen, in the first fortnight. The process below is designed to protect that window.

Who can claim workers compensation in NSW

Most people who work in NSW are covered, including many who assume they are not.

Generally covered

• Full time, part time and casual employees
• Apprentices and trainees
• Labour hire workers, usually through the labour hire agency's policy
• Many contractors and subcontractors who are deemed workers under the legislation
• Workers whose employer failed to hold a policy, through the uninsured liability scheme administered by icare

Covered under a different scheme

• Commonwealth and some national employers, covered by Comcare rather than the NSW scheme
• Coal miners, covered through Coal Services under a separate arrangement
• Exempt workers, including police officers, paramedics and firefighters, who retain different entitlements and were carved out of several of the 2026 psychological injury changes
• Workers in other states, where the claim usually follows the state of connection of the employment rather than where the injury happened

The type of injury matters too. NSW covers physical injury, psychological injury, disease and illness contracted or aggravated by work, and the aggravation of a pre existing condition where employment is the main contributing factor.

Note: Journey claims, meaning injuries travelling to or from work, are only compensable where there is a real and substantial connection between the employment and the incident. This is a much narrower test than most people expect, and it catches a lot of workers by surprise.

Info: If you are unsure whether you are covered, lodge anyway. It costs nothing to notify, and the insurer determines coverage. Not lodging costs you the claim.

What NSW workers compensation pays for

Understanding the entitlements makes the process easier to follow, because each step exists to unlock one of them.

• Weekly payments: income replacement while you have no capacity or reduced capacity for work.
• Medical and related expenses: reasonable and necessary treatment, including GP, specialist, surgery, physiotherapy, psychology, medication, aids and appliances.
• Travel: reasonable travel to and from approved treatment.
• Rehabilitation: workplace rehabilitation, functional assessment, vocational support and return to work programs.
• Permanent impairment lump sum: a one off payment where the injury results in permanent impairment above the relevant threshold.
• Work injury damages: common law damages where the employer was negligent and the impairment threshold is met.
• Death benefits: a lump sum, funeral costs and weekly payments to dependants.

Note: Superannuation contributions continue in defined circumstances, and back payment is generally owed from the date of injury once a claim is accepted. Workers often do not realise the back payment applies and never ask about it.

Step 1: Report the injury to your employer straight away

Tell your supervisor, manager or HR contact as soon as you can. Verbal notification is enough to start the clock, but follow it up in writing on the same day, even if it is a short email summarising what you said.

What to include:

• The date, time and exact location of the injury
• What you were doing at the time, described in plain terms
• What part of the body is affected, or for psychological injury, what happened and when
• Names of anyone who saw it or who you told
• Whether you have sought medical treatment

Your employer must record the injury in their register of injuries. Ask for a copy of the entry.

Tip: Do not wait to see if it settles down. This is the most common and most costly mistake in the entire process. An injury reported three weeks later invites the question of whether it happened at work at all, and the insurer is obliged to investigate that question rather than pay.

If you cannot tell your employer, because you are hospitalised, because the injury involves your manager, or because the relationship has broken down, you can notify the insurer directly. See Step 4.

Step 2: The employer notifies the insurer within 48 hours

This is a legal obligation on the employer, not a courtesy.

The employer must notify their insurer or claims service provider within 48 hours of becoming aware of a work related injury or illness. For most NSW businesses the insurer is icare, with claims managed by one of its claims service providers, currently EML, Allianz, GIO, Gallagher Bassett and QBE. Employers with their own arrangements notify their specialised or self insurer directly. Notification can be made through the icare online form, by phone, by email or by post.

Two things employers routinely get wrong here.

• They wait for paperwork. You do not need the Certificate of Capacity, the wage records or a completed claim form to notify. Notify with what you have and supply the rest as it arrives.
• They miss the five day mark. An excess may be payable if notification is not provided to the insurer within five calendar days of the employer becoming aware of the injury. Separately, from 30 June 2026 a new fixed excess applies to policies issued or renewed after that date, equal to the weekly compensation payable for the first week in which the worker's entitlement is above zero, plus the week immediately after.

Note: Serious incidents also require SafeWork NSW notification. If there is a death, a serious injury or illness, or a dangerous incident, the employer must notify SafeWork NSW immediately and preserve the site. This is a work health and safety obligation and sits alongside, not instead of, the insurance notification.

Info: For psychological injury claims notified from 1 July 2026, employers are now required to provide information about the relevant event said to have caused the injury when notifying the insurer. Vague notifications will be sent back.

Step 3: See a doctor and get a Certificate of Capacity

Seek medical attention as soon as possible, and tell the practitioner clearly that the injury is work related. That single sentence changes the paperwork they generate.

The Certificate of Capacity is the document that unlocks weekly payments. It is a SIRA form, not an ordinary medical certificate, and it does three jobs: it records the diagnosis, it sets out the treatment plan, and it states what work you can and cannot safely do.

• The first certificate must be completed by a medical practitioner, usually your GP or a hospital doctor. That doctor becomes your Nominated Treating Doctor, the central medical contact for the claim.
• Second and subsequent certificates can be issued by SIRA approved physiotherapists or psychologists for injuries within their scope of practice, using the designated form.
• A certificate should not cover more than 28 days unless the practitioner records a clinical reason for a longer period.
• You are responsible for making sure a current certificate is with the insurer. Weekly payments can stop simply because a certificate lapsed.

Note: Diagnosis language matters. For psychological conditions, terms like "stress" are not acceptable under the legislation and will trigger a request for further information, delaying the claim. A proper provisional diagnosis is better than a vague one.

Tip: Bring your job description or a list of your duties to the appointment. A doctor who can see your actual tasks can certify you fit for suitable duties rather than defaulting to unfit for all work. Certified capacity, even light or reduced hours, is almost always better for recovery and income than blanket unfitness.

Step 4: Lodge the claim

You do not need to wait for your employer. icare accepts injury notification and claim lodgement from three parties: the employer, the injured person, or an authorised representative such as a family member, union representative or lawyer.

Lodgement is done through the icare portal. Set aside 20 to 30 minutes and use a desktop computer rather than a phone, because the form is long and covers the injury, the employment, the earnings and the treatment.

Info: The form asks you to upload a Certificate of Capacity. You do not need one to submit. Lodge first, upload the certificate later once you have seen your doctor. Waiting for the certificate before lodging is a self inflicted delay.

Note: If you are employed by the NSW state government, do not use the public icare online form. Report to your employer, who manages the process on your behalf through their own arrangements.

Tip: Keep copies of everything. Every form, certificate, receipt, email and letter. Create one folder and put everything in it from day one. If the claim is ever disputed, that folder is your case.

Step 5: The first seven days

Once the notification is in, the process moves quickly. Within three days, the allocated case manager should contact the injured worker, the employer and the Nominated Treating Doctor to gather information. By day seven, the insurer must make an initial liability decision based on the factual and medical information available.

At that seven day point, one of three things happens.

• The claim is accepted. Weekly payments and medical cover commence.
• Provisional liability starts. If the insurer needs more information, it must commence provisional weekly payments within seven calendar days unless it has a reasonable excuse. Provisional liability allows up to 12 weeks of weekly payments and up to $10,000 in reasonably necessary medical treatment while the investigation continues. Provisional payments for medical expenses must commence unless the claim is declined outright.
• A reasonable excuse is issued. The insurer delays provisional weekly payments and must tell you why in writing. Even where a reasonable excuse applies to weekly payments, reasonably necessary medical expenses are generally still paid.

Info: Provisional liability is not an admission of liability. It is early support so that treatment is not delayed while the file is assessed. Employers sometimes resist notification because they think it signals acceptance. It does not.

Step 6: The liability decision

The insurer must determine liability once it has enough information, and no later than the end of the provisional period. In practice, straightforward claims are commonly decided within 21 days, and insurers are expected to decide as soon as they reasonably can rather than run the full 12 weeks.

During this period the insurer may request wage records and payslips to calculate your Pre Injury Average Weekly Earnings, ask for clinical notes or a treating doctor report, arrange an independent medical examination, arrange a factual investigation involving recorded interviews, or refer you for a workplace assessment or functional capacity evaluation.

Note: None of this means the claim is in trouble. It means the file is being built. Cooperate, answer accurately, and keep your own record of what you said.

Step 7: Build the recovery at work plan

If the claim involves time off or reduced capacity, an injury management plan and a return to work plan should be developed. This is where claims are actually won or lost.

The plan should name the suitable duties available, described as real tasks rather than "light duties". It should set hours and days with a graded upgrade schedule, name who supervises the arrangement, set review dates tied to the next certificate, and state what triggers a change in either direction.

Employers have a legal obligation to provide suitable work where the worker has some capacity and suitable work is reasonably practicable. Workers have a corresponding obligation to participate in the plan and make reasonable efforts to return to work.

Tip: "We have nothing available" is rarely a defensible position without a documented assessment of what the role and the site actually contain. If you genuinely cannot identify suitable duties, get a job task analysis done rather than leaving it as an assertion.

Info: The evidence here is not ambiguous. Good work is good for health. Workers who stay connected to the workplace recover faster physically and psychologically, and the longer someone is completely away from work, the lower their chance of ever returning.

Step 8: Keep the claim moving

• Get a new Certificate of Capacity before the current one expires
• Declare any earnings, including other jobs, on each certificate
• Attend appointments and keep receipts
• Tell the insurer promptly if your capacity changes
• Keep talking to your employer, even on the weeks when nothing changes

Info: Silence is what turns a 6 week claim into a 60 week claim. It is the cheapest thing on this list to fix and the most frequently neglected.

The claim timeline at a glance

• Immediately: injury reported and recorded in the register of injuries.
• Immediately: SafeWork NSW notified if there is a death, serious injury or dangerous incident.
• Within 48 hours: employer notifies the insurer or claims service provider.
• Within 5 calendar days: notification made, or an excess may become payable.
• As soon as possible: medical treatment obtained and Certificate of Capacity issued.
• Within 3 days of notification: case manager contacts worker, employer and treating doctor.
• By day 7: initial liability decision, provisional payments commence, or reasonable excuse issued.
• Up to 12 weeks: provisional liability period, covering up to 12 weeks of weekly payments and up to $10,000 in medical treatment.
• Commonly within 21 days: formal liability decision, and no later than the end of the provisional period.
• Within 6 months of injury: claim lodged, subject to limited exceptions.
• Week 13: first step down in the weekly payment rate.
• Week 130: second review point, with written application required to continue.

Tip: Employers should map these dates into their incident process rather than relying on memory. The 48 hour and five day marks in particular are easy to miss and expensive to explain later.

What you get paid

Weekly payments are calculated from your Pre Injury Average Weekly Earnings, or PIAWE, generally based on your earnings over the 52 weeks before the injury and including overtime, shift allowances and, in defined circumstances, a second job.

• Weeks 1 to 13: up to 95% of PIAWE, less any current earnings.
• Weeks 14 to 130: 95% of PIAWE less current earnings if you are working 15 or more hours per week. 80% of PIAWE if you have no capacity or are working less than 15 hours per week.
• After 130 weeks: up to 80% of PIAWE, subject to eligibility.

Note: There is a cap. All of the above is subject to the maximum weekly compensation amount, which SIRA indexes every April and October. Higher income earners will hit the cap and receive less than the stated percentage of their actual earnings. Always check the current figure on the SIRA site.

Tip: The 15 hour rule is significant. Returning to 15 or more hours per week from week 14 keeps you on the 95% rate rather than dropping to 80%. This is one of the strongest financial arguments for a structured graded return rather than waiting for full recovery.

Info: Continuing past 130 weeks requires action. The worker must apply in writing before the end of the 130 week period, and the insurer must conduct a work capacity assessment. Payments generally cease at 260 weeks unless permanent impairment exceeds the relevant threshold.

Medical and treatment expenses

Reasonable and necessary medical and related treatment is covered where it relates to the work injury.

Note the wording. The 2026 reforms changed the test for medical treatment costs on qualifying injuries from "reasonably necessary" to the higher standard of "reasonable and necessary". In practice this means treatment requests need clearer clinical justification, particularly for long running passive treatment, high risk medication and open ended therapy.

Tip: Treating practitioners should document the rationale, the expected duration and the functional goal of the treatment. Requests that describe a functional outcome are approved far more readily than requests that describe a modality.

Note: Some services require pre approval. If you are unsure, ask the case manager before booking rather than after.

Time limits: how long do you have to lodge?

The safe answer is six months from the date of injury.

Claims made outside six months can still be accepted in defined circumstances, including where the delay was caused by ignorance, mistake, absence from the state or another reasonable cause, and longer periods apply for claims involving death or serious and permanent injury. Disease and gradual onset injuries are dated differently again, generally from when the worker first became aware of the condition and its connection to work.

Info: None of that is a reason to wait. Every month of delay makes the medical link harder to establish and the factual account harder to corroborate. If you are outside six months, lodge and get advice rather than assuming you have lost the right to claim.

What changed on 1 July 2026

This is the biggest change to the NSW scheme in more than a decade, and it is the single largest gap in most of the guides still sitting online.

The reforms came through two pieces of legislation: the Workers Compensation Legislation Amendment Act, passed in November 2025, and the Workers Compensation Legislation Amendment (Reform and Modernisation) Act 2026, passed in February 2026. Some administrative and premium provisions commenced on 27 March 2026. The substantive changes to entitlements and thresholds took effect from 1 July 2026.

1. A new eligibility test for primary psychological injury

For psychological injuries notified on or after 1 July 2026, the injury is only compensable where it was caused by one or more defined relevant events, where there is a real and direct connection between that event and the employment, and where employment is the main contributing factor. Relevant events include categories such as witnessing a traumatic incident, or witnessing a dead or seriously injured person at the scene of a traumatic incident.

2. A strengthened reasonable management action defence

Where the significant cause of the psychological injury was reasonable management action taken by the employer, no compensation is payable.

Info: Performance management, restructures, investigations and disciplinary processes conducted reasonably now fall on the employer's side of this line. That raises the value of running those processes properly and documenting them at the time, not reconstructing them afterwards.

3. A separate pathway for bullying and harassment claims

Conduct based psychological injury claims arising from bullying, harassment or excessive workplace demands now run through a distinct process with new particulars requirements, a reasonable person test and stricter evidentiary requirements. A new workers compensation bullying and harassment jurisdiction has been established in the NSW Industrial Relations Commission.

4. Higher impairment thresholds for long term psychological injury benefits

Weekly payments for most primary psychological injuries are limited to 130 weeks unless the worker meets an increased whole person impairment threshold. The threshold rises over time, stepping up again from 1 July 2027 and again from 1 July 2029.

Note: The tiering here is genuinely complex, and the exact figure depends on when the claim was notified and which entitlement is in question. Check the current SIRA guidance or get advice rather than relying on any summary, including this one.

5. A single permanent impairment assessment

There is now one principal assessment used to determine all entitlements, including weekly payments, medical expenses, lump sum compensation, commutations and work injury damages. A further assessment is only available where there has been an unexpected and material deterioration of at least a further 10%.

6. A higher medical treatment test

As above, "reasonable and necessary" replaces "reasonably necessary" for qualifying injuries.

7. Premium and excess changes

The Nominal Insurer's premium target collection rate is frozen for the 2026 to 2027 and 2027 to 2028 policy years. A new fixed employer excess applies to policies issued or renewed on or after 4pm on 30 June 2026.

8. Expanded return to work support

Additional medical and vocational support programs have been introduced for workers who do not meet the higher thresholds.

Note: The psychological injury changes do not apply to coal miners, volunteers, or exempt workers including police officers, paramedics and firefighters.

Info: What this means practically. For employers, prevention and documentation now carry far more weight than they did twelve months ago. Psychosocial hazard management, properly run management processes and early intervention on emerging distress are the difference between a matter that resolves internally and one that becomes a contested claim in a new jurisdiction. For workers, psychological injury claims now require a clearer factual account of specific events, recorded early and in detail.

Psychological injury claims: what to do differently

Psychological injury claims follow the same lodgement steps, but the preparation matters more.

If you are the worker

• Write down specific events with dates, locations and people present. Under the new test, a general account of a difficult workplace is much weaker than a documented sequence of identifiable events.
• Keep contemporaneous records. Emails, messages, rosters, meeting notes.
• See your GP early and ask for a proper diagnosis on the certificate.
• Understand that an internal grievance and a workers compensation claim are different processes with different tests, and one does not replace the other.

If you are the employer

• Provide the information about the relevant event when notifying the insurer, as now required.
• Do not delay notification because the claim looks contestable. Notification is not agreement.
• Keep management action documented, proportionate and procedurally fair, as a matter of routine rather than as a response to a claim.
• Consider early psychological screening and early intervention.

Tip: Distress identified at week two is a support conversation. Distress identified at week twenty is a claim. The cost difference between those two points is measured in tens of thousands of dollars.

The employer's obligations

• Hold a policy. Every employer with workers must hold a workers compensation policy unless exempt.
• Register of injuries. Maintain one, and make it accessible to workers.
• Notify within 48 hours of becoming aware of an injury or illness.
• Notify SafeWork NSW immediately for a death, serious injury or illness, or dangerous incident.
• Return to work program. Have a documented program in place and make workers aware of it.
• Return to work coordinator. Employers above the relevant premium threshold, and self and specialised insurers, must appoint a trained coordinator.
• Provide suitable work where the worker has capacity and it is reasonably practicable.
• Do not dismiss. It is an offence to dismiss a worker because of a work related injury within six months of them becoming unfit.
• Cooperate with injury management and return to work planning.

Info: The cost drivers most employers underestimate are time to notification, absence of suitable duties, the 13 week and 130 week marks where claim cost accelerates disproportionately, untreated psychological overlay on physical claims, and poor communication. Workers who feel abandoned by their employer are far more likely to seek legal representation and far less likely to return.

Ten mistakes that delay or derail a claim

• Waiting to see if it settles down. Report on day one, every time.
• Reporting verbally with no written record. Follow up in writing the same day.
• Not telling the doctor it is work related. Without that, you get an ordinary medical certificate and no claim.
• Waiting for the Certificate of Capacity before lodging. Lodge first, upload later.
• Letting the certificate lapse. Payments stop. Book the next appointment before the current certificate expires.
• Vague diagnosis language, particularly on psychological claims. It triggers investigation and delay.
• Employers missing the 48 hour and 5 day windows. Avoidable and expensive.
• Describing suitable duties as "light duties". Name the actual tasks, hours and supervisor, or the plan will not hold.
• Not declaring earnings. Undeclared earnings on a certificate is a serious issue with penalties attached. Declare everything.
• Going silent. Both directions. Workers who stop hearing from their employer disengage, and disengaged workers do not return.

Note: Nine of these ten cost nothing to avoid. They are process failures, not resourcing failures, which is why they are worth building into your incident checklist rather than leaving to judgement on the day.

If your claim is rejected or payments stop

A declined claim is not the end of the process. NSW has multiple review pathways, and several are free.

• Ask for the reasons in writing. The insurer must give you a written decision explaining why. Many declines rest on a single factual point that can be corrected with better evidence.
• Request an internal review. Ask the insurer to reconsider, and supply whatever was missing: a clearer certificate, a specialist report, a witness statement, corrected wage records.
• Contact the Independent Review Office. IRO is a free, independent service for injured NSW workers. Through the Approved Lawyers Scheme, IRO funds legal advice and representation in disputed claims.
• Lodge a dispute with the Personal Injury Commission. The PIC resolves workers compensation disputes, including liability, weekly payments, medical expenses and permanent impairment.
• Bullying and harassment matters now have a dedicated jurisdiction in the NSW Industrial Relations Commission.

Info: The IRO Approved Lawyers Scheme means you can generally get a workers compensation lawyer without paying for one. A surprising number of injured workers accept a decline because they assume legal help is unaffordable.

Note: Work capacity decisions, where the insurer decides you have capacity and reduces or stops payments, have their own review pathway and their own timeframes. Do not accept a reduction you disagree with without checking your review rights.

Key takeaways

The NSW claims process is built around a small number of hard deadlines. Report immediately, notify within 48 hours, get a proper Certificate of Capacity, and lodge without waiting for paperwork you do not yet have. Do those four things and the system generally works the way it is meant to.

The 2026 reforms have raised the stakes on the employer side in particular. Psychological injury claims now turn on documented events and defensible management action, which means the work that protects you happens well before anyone lodges anything.

How Actevate can help

Actevate has been an approved workplace rehabilitation provider since 2006, working with some of Australia's largest employers on both prevention and recovery.

• Manage the claim properly from day one. Our return to work consultants coordinate suitable duties design, case conferencing and planning for both physical and psychological injuries.
• Catch complications early. Pathways, our digital screening solution, identifies workers whose recovery is likely to be compromised by mental health factors, so we can act before a straightforward physical claim becomes a complex psychological one.
• Build capability before you need it. Our mental health training gives leaders and HR teams the skills to recognise psychosocial risk and respond early, which matters more than ever under the new rules.
• Prevent the next claim. Our manual handling training and ergonomic assessments reduce the risk of injuries happening in the first place.

Tip: You can choose your own rehabilitation provider, and you can change providers if a claim has stalled. We always recommend that workers and employers exercise that choice, because recovery is personal and every claim is different.

If you have a claim that is not progressing, make a referral and a return to work specialist will call you back within one business day. For everything else, call 1300 663 155 or get in touch.

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This article provides general information about the NSW workers compensation scheme as at August 2026. It is not legal, medical or financial advice. The scheme changed significantly on 1 July 2026 and further changes are scheduled for 2027 and 2029. Entitlements depend on individual circumstances, the date of injury and the date of notification. For advice on a specific claim, speak to Actevate, your insurer, SIRA, or a qualified legal practitioner.