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 Independent Review Office (IRO).
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.
