Liability disputes

Where the insurer disputes liability for your workers compensation claim they will advise you of their reason(s) in writing (this is called a decision notice) and provide information on the next steps available to you.

For guidance, you can use or simply refer to the Review form - application for review by the insurer.

Examples of when disputes can happen include:

• the insurer does not consider the person making the claim to be a ‘worker’ (under the legislation)
• the insurer considers that employment was not a substantial contributing factor to the injury
• it was not 'reasonably necessary' to have the medical treatment or other claim-related expenses.

When disputes happen there is help available to have it resolved.

Request a review by the insurer

You may contact the insurer and request they review the decision.

When requesting a review, include any additional information you think is relevant to help the insurer review the decision.

The insurer must respond to you in writing within 14 days of receiving the request for a review. The insurer will either decide to overturn or modify the original decision or maintain the decision.

If the insurer fails to attach all relevant documents to the decision notice, then they must correct the decision notice(s) as soon as they become aware.

Contact IRO

You (the worker) can contact the Independent Review Office (IRO) if you are dissatisfied at any stage during this process.

IRO is an independent statutory office with a variety of roles, including helping find solutions to disputes by contacting the insurer on your behalf.

Where disputes cannot be resolved, the IRO may advise you and your representative to get advice from a lawyer approved under the Independent Legal Assistance and Review Service (ILARS). The lawyer will review your case and may make an application to IRO to see if funding is available to help resolve the dispute in the Personal Injury Commission.

For more information on how IRO can help:

• visit their website,
• call IRO on 13 94 76, or
• send an email to [email protected].

Apply to the Personal Injury Commission to resolve the dispute

If you do not wish to seek a review by the insurer or are not satisfied with the insurer's decision after a review, you can lodge an application to resolve the dispute at the Personal Injury Commission.

The Personal Injury Commission is a single, independent tribunal for injured people claiming against the workers compensation or compulsory third party (CTP) insurance schemes. The Personal Injury Commission helps resolve workers compensation disputes between injured workers and, employers/insurers, including disputes relating:

• work capacity decisions
• weekly payments and compensation
• medical, hospital and related expenses
• permanent impairment compensation
• compensation for damage to personal property
• compensation for domestic assistance.

The process for resolving your dispute depends on the type of matter that is in dispute.

Further information

For more information you can visit the Personal Injury Commission website or call 1800 PIC NSW (1800 742 679).

Read more about steps to resolve a liability dispute in our claims management guide.