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Workers compensation decision notice summary - the approved form

Insurer requirements

General introduction

Publication

This document is approved and published by the State Insurance Regulatory Authority (SIRA) under clause 38(1)(h) of the Workers Compensation Regulation 2016.

Commencement of the decision notice summary

The requirement to issue a summary in the approved form applies to insurer decision notices issued under section 78 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) from 1 July 2019.

Summary making power

This document details the form in which the summary of the decision is required to be provided in a decision notice issued under section 78 of the 1998 Act, as required by clause 38(1)(h) of the Workers Compensation Regulation 2016.

When to issue the summary

Unless otherwise stated, the decision notice summary is to be issued in the approved form whenever a decision is made by the insurer that results in a notice being given under section 78 of the 1998 Act.

Summary for the decision

In accordance with clause 38(1)(h) of the Workers Compensation Regulation 2016 the insurer must include a summary, in the approved form, of:

  • the effect of the decision
  • the worker’s rights of review of the decision
  • the procedure for requesting a review, and
  • legal and other services that may be available to the worker to provide advice or assistance in relation to the dispute.

Glossary

Decision The decision made by the insurer
Date of the decision The date the decision was made by the insurer
Date the application takes effect The date the decision takes effect (that is, a date after the required period of notice has expired in accordance with section 80 of the 1998 Act and, where applicable, taking into account the effect of the service by post rule under section 76 of the Interpretation Act 1987).

Part 1: Work capacity decisions

The insurer must give notice of a work capacity decision to discontinue or reduce the amount of weekly payments of compensation as required by section 78(1)(b) of the 1998 Act.

Summary of the decision

The box below provides the relevant summary in the approved form, which must be included (as written) and positioned on the front page of the insurer decision notice, to discontinue or reduce the amount of weekly payments of compensation.

Summary of the decision

Decision

Date of the decision

Date the decision takes effect

Important Notice

This notice sets out an important decision by <insert insurer name> (the insurer) about your workers compensation claim.

You should get advice from your union, a lawyer or your insurer immediately if you are unsure about what this notice means or would like to challenge (dispute) the decision.

The Workers Compensation Independent Review Officer (WIRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. WIRO has a list of approved lawyers who can give you advice which may be at no cost to you. This list is available on the WIRO website wiro.nsw.gov.au or you may call WIRO on 13 94 76 or email: contact@wiro.nsw.gov.au.

If you disagree with all or part of the decision, you have the right to a review at any time. You or your legal representative can choose to:

  • have the decision reviewed by someone else at <insert insurer name>, or
  • lodge a dispute with the Workers Compensation Commission (Commission), with or without a completed review (even if already requested) from <insert insurer name>. You can go to the Commission directly, or with assistance from a lawyer.

If you lodge a dispute with the Commission before the date the decision takes effect, and you have been in receipt of weekly payments for at least 12 weeks, no changes will be made to your weekly benefits until the dispute proceedings are finalised in the Commission.

For more information, go to the SIRA website www.sira.nsw.gov.au

Part 2: Liability decisions

The insurer must give notice of a liability decision to dispute liability in respect of a claim or any aspect of a claim as required by section 78(1)(a) of the 1998 Act.

Summary of the decision

The box below provides the relevant summary in the approved form, which must be included (as written) and positioned on the front page of the insurer decision notice to dispute liability in respect of a claim or any aspect of a claim.

Note: Different requirements exist for work injury damages claims (clause 38A of the Workers Compensation Regulation 2016)

Summary of the decision

Decision

Date of the decision

Date the decision takes effect

Important notice

This notice sets out an important decision by <insert insurer name> (the insurer) about your workers compensation claim.

You should contact your union, a lawyer or your insurer immediately if you are unsure about what this notice means or would like to challenge (dispute) the decision.

The Workers Compensation Independent Review Office (WIRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. WIRO has a list of approvied lawyers who can give you advice which may be at no cost to you. This list is available on the WIRO website wiro.nsw.gov.au or you may call WIRO on 13 94 76 or email at contact@wiro.nsw.gov.au.

If you disagree with all or part of the decision, you have the right to a review at any time. You or your legal representative can choose to:

  • have the decision reviewed by someone else at <insert insurer name>, or
  • lodge a dispute with the Workers Compensation Commission (Commission), with or without a completed review (even if already requested) from <insert insurer name>. You can go to the Commission directly, or with assistance from a lawyer.

For more information, go to the SIRA website www.sira.nsw.gov.au

Part 3: Decisions - exempt workers

The insurer must give notice of a decision to dispute liability in respect of a claim or any aspect of a claim, or discontinue or reduce the amount of weekly payments of compensation as required by section 78(1)(a) and (b).

Exempt categories of workers

The following summary applies to an insurer decision notice for:

  • exempt categories of workers (police officers, paramedics or fire fighters)
  • volunteers prescribed by the Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987.

Summary of the decision

The box below provides the relevant summary in the approved form, which must be included as written and positioned on the front page of the insurer decision notice, to discontinue or reduce an entitlement to workers compensation benefits.

Summary of the decision

Decision

Date of the decision

Date the decision takes effect

Important notice

This notice sets out an important decision by <insert insurer name> (the insurer) about your workers compensation claim.

You should contact your union, a lawyer or your insurer immediately if you are unsure about what this notice means or would like to challenge (dispute) the decision.

The Workers Compensation Independent Review Office (WIRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. WIRO has a list of approvied lawyers who can give you advice which may be at no cost to you. This list is available on the WIRO website wiro.nsw.gov.au or you may call WIRO on 13 94 76 or email at contact@wiro.nsw.gov.au.

If you disagree with all or part of the decision, you have the right to a review at any time. You or your legal representative can choose to:

  • have the decision reviewed by someone else at <insert insurer name>, or
  • lodge a dispute with the Workers Compensation Commission (Commission), with or without a completed review (even if already requested) from <insert insurer name>. You can go to the Commission directly, or with assistance from a lawyer.

For more information, go to the SIRA website www.sira.nsw.gov.au

Version number

The current Decision notice summary is Version 1.1 (published 1 July 2019).

Version number Effective date
Version 1 21 December 2018 to 30 June 2019
Version 1.11 July 2019 to current