Resolving complaints and disputes

The Personal Injury Commission (the Commission) is an independent tribunal that helps resolve workers compensation disputes between workers and insurers (amongst other matters). The Commission has jurisdiction to examine, hear and determine all matters arising under the NSW Workers Compensation Acts.

The Commission deals with disputed claims for compensation including weekly compensation, medical expenses compensation, lump sum compensation for permanent impairment and payments in respect of deceased workers. The issues in a dispute could include whether the injury happened at work, whether work was a substantial contributing factor to the injury, whether the injured person was a worker, which body parts were injured, and the amount of compensation payable.

Note: The Commission will provide an interpreter if a worker requires, at no cost to the worker.

Commission rules, procedural directions and policies

The Personal Injury Commission Rules 2021 (the Rules) direct the operation of the Commission, covering the procedures in proceedings.

Procedural directions provide a more detailed explanation of the Commission’s procedures.

The Commission’s policies set standards of practice for the Commission and the people who use the Commission’s services. Policies cover a wide range of issues, such as Media Policy, Security at the Commission, Access to Compensation Court records, Complaints Policy and Codes of Conduct for Mediators, Medical Assessors, Members and Merit Reviewers.

Structure of the Commission

The diagram below details the structure of the Commission:

President and Deputy Presidents

The President works with the principal registrar and Division Heads in a strategic leadership role. The President is also responsible for appointing medical assessors, merit reviewers and mediators, issuing procedural directions and other administrative and legal tasks.

Presidential members hear appeals against decisions made by members in the Workers Compensation Division.

Appeals against Presidential decisions are heard in the NSW Court of Appeal.

Division Heads

The Personal Injury Commission has two divisions, the Workers Compensation Division and the Motor Accidents Division. The Division Head directs the business of the Division.

Principal Registrar

The principal registrar assists the President in managing the business and affairs of the Commission.

Members

Members are experienced, independent decision-makers that resolve disputes heard in the Commission. Each member must follow procedural directions given by the President and the relevant Division Head.

Disputes in the Commission

Unresolved workers compensation disputes can be brought to the Commission for resolution or determination.

Disputes regarding the degree of permanent impairment may be referred to a medical assessor for medical assessment.

Most other claims, such as weekly benefits compensation, medical expenses, or where liability is disputed in relation to a claim for permanent impairment, will be referred to a member.

The Commission resolves disputes through informal negotiation and formal hearings.

The resolution pathway tries to resolve the dispute by agreement between the parties using informal dispute resolution. Initially, this is done through a teleconference. If the parties cannot resolve the matter at this stage, it will proceed to a conciliation conference.

If the dispute is not resolved at the teleconference or conciliation conference, it will progress to a formal arbitration hearing where the Commission will decide the dispute.

The Commission’s flexible approach provides multiple mechanisms for how the conciliation conference and arbitration hearing are conducted. Parties can attend in person, via telephone, or via videoconferencing, depending on the circumstances of the case and external factors.

More information is available on the Commission website and in the Commission videos.

Workplace injury management disputes

A workplace injury management dispute is a dispute about the activities and procedures undertaken to achieve a timely and safe return to work.

A worker, an insurer, or an employer can lodge an application with the Commission. Applications can only be made after the worker has made a claim to the employer and/or insurer involved.

The Commission has published a short video on how the Commission assists in settling workplace injury management disputes.

Medical disputes

A dispute regarding a worker’s condition, fitness for employment and degree of permanent impairment may be resolved through the Commission's medical disputes pathway.

Where a worker is not satisfied with an insurer’s decision on the assessed degree of permanent impairment, they can lodge an application to the Commission to have the degree of permanent impairment assessed. In most situations, the matter will be referred to a medical assessor for an assessment.

Medical Assessors

The Personal Injury Commission appoints independent medical assessors (previously called approved medical specialists) to assess a worker’s injury, or their condition or fitness for employment, or the degree of permanent impairment. They are highly experienced medical practitioners who are qualified in a range of medical specialties.

The medical assessor will provide a medical assessment certificate. The certificate will outline their assessment of the worker’s injury or condition. Based on this assessment the worker, the employer and the employer’s insurer may agree to resolve the dispute and agree on the amount of compensation payable. If a dispute continues, or there are outstanding issues to be resolved, the Commission may refer the matter to a Member to resolve the dispute.

Medical assessors do not give advice or recommend treatment for the worker.

Appeals and reconsiderations

Decisions made by the Commission may be appealed or reconsidered.

Refer to the Commission's website for further information.

Legal costs