About the SIRA workers compensation claims management guide

The SIRA workers compensation claims management guide (claims management guide) is an easy to use, centralised information source for all stakeholders in the NSW workers compensation system.

This online platform allows users to better navigate the legislative and regulatory landscape, providing a ‘one stop shop’ for NSW workers compensation claims management information. It provides a comprehensive range of information and related topics to help insurers make decisions in-line with legislation and community expectations, and helps workers understand their entitlements.

The claims management guide includes several different sections and graduated information tiers:

  • learn the main points in the claims journey, from injury to claim closure
  • read comprehensive Insurer guidance
  • refer to the workers compensation legislation and regulation
  • read SIRA guidelines and other regulatory instruments, including the standards of practice
  • find explanations of common terms in the glossary.

The purpose of each section is outlined below in 'Using the claims management guide'.

Note: If you are a worker and you have received a work-related injury or illness, you need to notify your employer and/or your employer’s insurer. Find out what to do when there's been an injury on the SIRA website.

The claims management guide can be used in a number of ways. It can be read section by section, or by topic. Use the search bar to find specific information or browse by resource. Each section allows the user to delve deeper with in-text links and related resources.

Guidance information contained in the claims management guide is provided for general information and assistance only.

Insurers and other stakeholders should ensure that claims are managed in accordance with legislative and regulatory requirements.

Workers with enquiries regarding their specific circumstances should liaise with their insurer in the first instance. If their enquiry cannot be resolved by the insurer, workers can seek advice from their legal representative, union delegate, or the Workers Compensation Independent Review Office (WIRO).

Understanding the claims journey

This section explains the workers compensation claims journey in plain English.

It introduces the workers compensation claims process, and includes general information about the main aspects of a claim from notifying the insurer of an injury, to insurer claims management, worker treatment, recovery and claim closure.

This section is ideal for workers and other stakeholders new to the workers compensation system. It also provides links to other information if the reader wishes to learn more about each topic.

Insurer guidance

This section is designed to provide insurers with guidance on a comprehensive range of claims management topics. The information is to be read together with the relevant workers compensation legislation, regulation, guidelines and standards of practice.

Insurer guidance includes guidance notes to help insurers comply with the legislation, and understand what SIRA considers acceptable practice within the system.

To encourage and aid consistency across the industry, guidance notes may include:

  • general information
  • standard templates
  • forms, and
  • administrative processes.

Legislation and regulatory instruments

Legislation

The NSW workers compensation system is primarily governed by the Workers Compensation Acts and Regulation. These are the:

This legislation represents the law as it relates to workers compensation in NSW. It is the primary source for all guidance laid out in the claims management guide.

Other Acts and Regulations also apply and are referenced throughout the claims management guide where applicable.

Guidelines

The Guidelines section expands on the workers compensation legislation. It contains relevant workers compensation guidelines issued by SIRA in accordance with specific guideline-making powers contained in the Acts.

Guidelines support delivery of the objectives of the Acts and Regulation by informing and guiding insurers, workers, employers, injury management consultants, independent medical examiners and other stakeholders in workers compensation claims processes in NSW.

Standards of practice

The Standards of practice (the Standards) detail SIRA expectations for claims handling and conduct for insurers operating in the NSW workers compensation system.

The Standards:

  • contain overarching claims management principles that are intended to apply generally to all claims handling and administration activities
  • are made up of individual standards which apply to claims management topics, and include the principle, expectations and benchmarks
  • provide direction on claims handling and administrative processes
  • support the effective and efficient management of claims
  • promote system-wide consistency, equity and fairness.

The information contained in the claims management guide is provided for information purposes only. While reasonable care is taken to keep the content updated, SIRA makes no warranties about its accuracy, currency or suitability for any particular purpose. See SIRA’s full disclaimer for more information.

Google Translate

You can use Google Translate to access information in the Claims management guide in different languages. This automatic translation service is free to use and facilitates the instant access to information but may not provide an exact translation.

SIRA does not make any guarantee as to the accuracy of the translations using Google Translate and accepts no responsibility for any inaccurate or incomplete translation. The information should be used as a guide only.

SIRA a provides translator and language service. See SIRA's Languages page for further information.

The State Insurance Regulatory Authority (SIRA) regulates workers compensation insurance, motor accidents compulsory third party insurance and the home building compensation scheme in NSW.

We were established by the State Insurance and Care Governance Act 2015 as part of reforms to the NSW workers compensation system and are an independent agency located within the NSW Customer Service Cluster.

We focus on service delivery to injured people, and the effective management, affordability and sustainability of these insurance schemes. Learn more about us and what we do on the SIRA website.

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