- 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
S4. Liability for medical or related treatment
Making medical or treatment liability decisions promptly, in consultation with key stakeholders and based on all available evidence, will reduce the likelihood of disputes and ensure workers can focus on recovery and return to work.
Liability decisions will be informed by careful consideration of all available information and proactive consultation with relevant stakeholders.
When determining liability for medical or related treatment, insurers are to obtain and consider all relevant information, consult with the worker and relevant parties as required, and make a decision at the earliest possible opportunity.
Evidence on claim file
When a claim for medical or related treatment is received, the insurer is to acknowledge the request and keep the worker informed of the status of their claim.
Request acknowledged within 10 working days
The insurer is to advise the relevant parties of the outcome and reasons for a decision regarding liability for medical or related treatment.
Advice provided within two working days after decision
Making medical or treatment liability decisions promptly, in consultation with key stakeholders and based on all available evidence will reduce the likelihood of disputes and ensure workers can focus on recovery and return to work.
Insurers are required to make liability decisions at various points during a claim. Each time a worker makes a claim for medical or related treatment, the insurer is required to determine liability in accordance with the legislation. Insurers are to gather the relevant evidence, consult with key stakeholders and ensure that the decision is soundly based, made in a timely manner and communicated appropriately.
Liability decisions must be made in accordance with the legislation and informed through careful consideration of all evidence. Key to the principles of fairness and transparency is the observation of procedural fairness and proactive consultation with the worker and employer.
NSW workers compensation legislation requires liability to be determined within 21 calendar days after a claim for medical expenses has been made. If the treatment requested is already covered under the pre-approval provisions of the Workers compensation guidelines, the worker and provider are to be informed to avoid unnecessary delay.
Decisions should be made in a fair and transparent manner and include communication with the worker, nominated treating doctor and other relevant parties.