- Workers Compensation Act 1987
- Workplace Injury Management and Workers Compensation Act 1998
- Workers' Compensation (Dust Diseases) Act 1942
- Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987
- Workers Compensation Regulation 2016
- Workers Compensation (Dust Diseases) Regulation 2018
- Workers Compensation (Bush Fire, Emergency and Rescue Services) Regulation 2017
- Workers compensation guidelines
- NSW workers compensation guidelines for the evaluation of permanent impairment
- Workers compensation medical dispute assessment guidelines
- Guidelines for workplace return to work programs
- Workers compensation market practice and premiums guidelines
- Guidelines for the approval of treating allied health practitioners 2016 No 2
- Workers compensation licensed insurer business plan guidelines
Standards of practice
- Overarching claims management principles
- Standard of practice principles
- S1. Worker consent
- S2. Worker access to personal information
- S3. Initial liability decisions – general, provisional, reasonable excuse or full liability
- S4. Liability for medical or related treatment
- S5. Recurrence or aggravation of a previous workplace injury
- S6. Recoveries
- S7. Interim pre-injury average weekly earnings calculation
- S8. Insurer making weekly payments
- S9. Reduction in payments of compensation
- S10. Payment of invoices and reimbursements
- S11. Changes in capacity
- S12. Injury management plans
- S13. Additional or consequential medical conditions
- S14. Referral to an injury management consultant
- S15. Approval and payment of medical, hospital and rehabilitation services
- S16. Case conferencing
- S17. Section 39 Notification
- S18. Retiring age notification
- S19. Section 59A notification
- S20. Permanent impairment assessment reports
- S21. Negotiation on degree of permanent impairment
- S22. Insurer participation in disputes and mediations
- S23. Recovery of overpayments due to insurer error
- S24. Factual investigations
- S25. Surveillance
- S26. Arrangement for payments to Medicare Australia
- S27. Notification and recovery of Centrelink benefits from lump sum payments
- S28. Interpreter services
- S29. Cross-border provisions
- S30. Closing a claim
- S31. Death claims
- S32. Managing claims during the COVID-19 pandemic
- Workers compensation benefits guide
- Fees and rates orders
- Standards of practice
Overarching claims management principles
These overarching claims management principles apply generally across all aspects of claims management, to provide direction for the handling and administration of claims under the workers compensation system. These principles support the workers compensation system objectives outlined in section 3 of the 1998 Act.
Principle 1: Fairness and empathy
The management of claims will be undertaken in an empathetic manner intended to maximise fairness for workers by:
- ensuring that workers understand their rights, entitlements and responsibilities, and making clear what workers and employers can expect from insurers and other scheme participants, and
- ensuring workers are afforded procedural fairness and decisions are made on the best available evidence, focused on advancing the worker’s recovery and return to work.
Principle 2: Transparency and participation
Workers, employers and other scheme participants will be empowered and encouraged to participate in the management of claims by:
- ensuring transparent and timely communication of the reasons and information relied upon for decisions and facilitating right-of-reply, and prompt, independent review of decisions, and
- ensuring opportunities are provided to workers, employers and other scheme participants to contribute information that can support and inform claims management.
Principle 3: Timeliness and efficiency
Claims management decisions will be made promptly and proactively, and claims will be managed in a manner intended to reduce delays and costs and maximise efficiency by:
- promptly and efficiently processing claims, responding to inquiries, determining entitlements and making payments
- progressing claims without unnecessary investigation, dispute or litigation.
The overarching claims management principles apply generally across all aspects of claims management, to provide direction for the handling and administration of claims under the workers compensation system. These principles support the workers compensation system objectives outlined in section 3 of the 1998 Act.
Claims management that is supportive, non-adversarial and accessible can provide a positive experience for workers and employers, and focus the efforts of system participants to achieve the best possible return to work and health outcomes.
The management of claims should be undertaken in an empathetic manner, intended to maximise fairness for workers. A worker should not have to face significant challenges or barriers to access benefits to which they are entitled, and employers should be kept informed throughout the claims management process.
Honest and transparent communication underpins a fair and equitable workers compensation system. When workers, employers and other scheme participants are empowered and encouraged to participate in the management of a claim, they can fully contribute toward achieving the best possible return to work and health outcomes for the worker.
Model litigant principles apply to civil claims and civil litigation involving the NSW Government and/or its agencies. Where relevant, these principles have been incorporated. This means all insurers are required to maintain proper litigation standards within the workers compensation system, and ensure system objectives are prioritised.
The system objectives recognise that prompt, proactive and efficient action is needed to deliver optimal outcomes. Timely and efficient claims handling can reduce conflict, and allow more time to focus on worker and employer needs and outcomes.