Print PDF
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 decision 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 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 Independent Review Office (IRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. IRO 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 IRO website www.iro.nsw.gov.au or you may call IRO on 13 94 76 or email: [email protected]
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 Personal Injury 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 2016 Regulation).
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 Independent Review Office (IRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. IRO 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 IRO website iro.nsw.gov.au or you may call IRO on 13 94 76 or email: [email protected]
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 Personal Injury 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 Independent Review Office (IRO) provides a service to assist injured workers with understanding their rights and accepts enquiries or complaints about the conduct of an insurer. Call IRO on 13 94 76 or email: [email protected]
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 Personal Injury 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.
You may be entitled to costs for legal representation and may be able to recover these costs by an order of the Commission. For more information visit www.pi.nsw.gov.au or contact the Commission on 1800 742 679.
For more information, go to the SIRA website www.sira.nsw.gov.au
Version number
The current Decision notice summary is version 1.12 (published 1 March 2021).
| Version number | Effective date |
|---|---|
| Version 1 | 21 December 2018 to 30 June 2019 |
| Version 1.1 | 1 July 2019 to February 2021 |
| Version 1.2 | 1 March 2021 to current |