Workers Compensation in NSW: Claims, Weekly Payments, Lump Sums and Disputes

By James Stevens, Director and Solicitor, Go To Court Lawyers. Last reviewed 10 April 2026.

In NSW, an insurer must start provisional weekly payments within 7 days of being notified of a work injury unless it has a reasonable excuse; weekly payments are up to 95% of pre-injury average weekly earnings for the first 13 weeks and generally 80% after that, and usually stop after 260 weeks unless permanent impairment is more than 20%. A lump sum for permanent impairment needs more than 10% permanent impairment, or 15% for a psychological injury.

Checked on 23 October 2026 against icare and the Independent Review Office.

How to make a claim

1. Get first aid or medical help if you need it.
2. Tell your employer as soon as possible. Your employer must notify its insurer (its claims service provider) within 48 hours of you telling it.
3. If your employer has not notified the insurer, you, or someone you nominate such as a family member or your doctor, can notify icare online, which passes it to your employer's insurer. You will need your details, your employer's name and address, when and how the injury happened, a contact at work, and whether you had time off or treatment.
4. Get a certificate of capacity from your nominated treating doctor. You need a valid NSW workers compensation certificate of capacity to keep receiving weekly payments and treatment.
5. The insurer decides. It must tell you within 7 days whether it will start payments, or explain what is missing, and a claim should be decided within 21 days.

Most private-sector claims are managed through icare; NSW government employees are covered by the Treasury Managed Fund; some employers insure themselves. If your employer has no insurance, you can still claim, and icare manages the claim.

Weekly payments

• Provisional payments: if the injury has cost you earnings, the insurer must start weekly payments within 7 days of being notified, unless it has a reasonable excuse (which it must give you in writing). Provisional payments can last up to 12 weeks, with up to $10,000 of medical expenses, while the insurer assesses the claim. You do not have to repay them if the claim is later declined.
• How much: weekly payments are a percentage of your pre-injury average weekly earnings (PIAWE), up to a maximum weekly amount that is indexed. icare's guide sets them as up to 95% for the first 13 weeks; then, to 130 weeks, 80% if you cannot work or work under 15 hours a week, or 95% if you work 15 hours or more a week, less what you earn or could earn.
• After 130 weeks: payments continue only if you are assessed as likely to be off work indefinitely, or, after applying to the insurer, you work at least 15 hours a week, earn at least the indexed minimum and are assessed as unable to do more. Workers with permanent impairment of more than 20% do not need to meet the hours and earnings tests.
• The limit: payments generally stop after 260 weeks (5 years) unless your permanent impairment is more than 20%. For primary psychological injuries notified on or after 1 July 2026, the limit is 130 weeks.
• Payments can be reduced or stopped if you do not provide a certificate of capacity and declaration, do not meet your return-to-work obligations after notice, miss a medical appointment the insurer arranged, or are assessed as able to earn in suitable work.
• Retirement age: if you were injured before reaching retiring age, weekly payments can continue for up to 12 months after you reach it.

Psychological injuries reported from 1 July 2026

Tighter rules apply to psychological injuries notified on or after 1 July 2026:

• All primary psychological injuries: weekly payments are limited to 130 weeks, and medical treatment to 12 months after weekly payments stop, unless permanent impairment is more than 30%. To sue the employer you need at least 25% permanent impairment, rising to more than 26% from 1 July 2027 and 28% or more from 1 July 2029.
• Injuries caused by bullying, racial harassment, sexual harassment or excessive work demands (called "relevant conduct") get interim payments instead of provisional payments: 75% of your PIAWE for up to 56 days, plus up to $7,500 of medical and related treatment, while the insurer decides. You do not have to repay them if the claim is declined.
• Relevant conduct disputes: if you disagree with the insurer's decision on such a claim, ask for an internal review, then you can go to the Industrial Relations Commission. Its decision on whether the conduct was relevant conduct is final, and the Personal Injury Commission cannot deal with the claim until it is made.

Medical and rehabilitation expenses

• What is covered: reasonably necessary treatment for the injury, including doctors, physiotherapists, psychologists and other allied health, hospital treatment, ambulance, equipment and aids, attendant care and domestic help, and home or vehicle changes. The insurer usually pays providers directly.
• Approval: most treatment needs the insurer's approval first. Treatment in the first 48 hours, visits to your nominated treating doctor and emergency department care are among the exceptions.
• How long: with no permanent impairment or 1% to 10%, until 2 years after weekly payments stop (or 2 years from the claim if there were none); 11% to 20%, until 5 years after weekly payments stop; more than 20%, for life.

Lump sums and commutations

• Permanent impairment lump sum: available if your permanent impairment is more than 10% (15% for a primary psychological injury), on top of weekly payments and medical expenses. You can make only one permanent impairment claim per injury, and you must get independent legal advice first.
• How much: the maximum for injuries on or after 5 August 2015 was $584,580 (plus 5% for back impairment) and is indexed every year.
• Timing: once it has everything it needs, the insurer has two months to dispute the claim or make an offer.
• Exempt workers (police officers, paramedics, firefighters, volunteer bush firefighters and emergency rescue volunteers) have different rules, with no minimum impairment.
• Commutations (a lump sum that ends your weekly and medical entitlements): from 1 October 2026 to April 2028, three more classes of workers can ask, by giving their insurer SIRA's expression of interest form. You must get independent legal advice, and financial advice for more than $100,000.

Suing your employer: work injury damages

If your employer's negligence caused the injury, you may be able to sue the employer for work injury damages. You need at least 15% permanent impairment (higher for psychological injuries notified from 1 July 2026) and must have received your statutory lump sum. Most workers can claim only past and future loss of earnings. Court proceedings cannot start until 6 months after the injury was reported, must start within 3 years of the injury unless the court allows otherwise, and need a pre-filing statement and usually mediation first. A settlement ends all your workers compensation entitlements for that injury.

If you disagree with the insurer

• Internal review: if you disagree with a decision, ask the insurer for an internal review; it must respond within 14 days.
• Complain to the IRO: the Independent Review Office deals with complaints about insurers, such as payments reduced, stopped or delayed, and raises them with the insurer.
• Personal Injury Commission: you can lodge a dispute with the Commission, which resolves disputes between workers, employers and insurers, about liability (whether your claim is accepted), permanent impairment, injury management, and medical, hospital and rehabilitation expenses, or if the insurer fails to decide your claim.
• Free legal help (ILARS): the IRO can fund an approved workers compensation lawyer for a dispute with an insurer, if it is satisfied the matter has a reasonable chance of success. It aims to decide funding within 5 business days. It is for non-exempt workers.
• Time limits apply to some claims, so contact the IRO or a lawyer early.

Free help in NSW

For a complaint about your employer or a provider, icare points to the State Insurance Regulatory Authority (SIRA) on 13 74 72.

How Go To Court Lawyers can help

Our free line, 1800 577 015, answers at any hour. Jen, our AI legal information assistant, gives general legal information and takes your details; Jen is not a lawyer and does not give advice about your case. A 60-minute consultation with a lawyer who practises in New South Wales is a fixed $295, by phone, video or in person where the lawyer offers it. The lawyer can review the insurer's decision, explain your entitlements and the time limits, advise before a permanent impairment claim or commutation, and act for you in the Personal Injury Commission. Requests are taken at any hour; how soon a lawyer can see you depends on who is available. Request a $295 consultation.

General information only, not legal advice. Updated 23 October 2026. Checked against icare's pages on notifying an injury, weekly payments, types of payments, medical and rehabilitation expenses, permanent impairment claims, work injury damages, commutations and disputes, and the Independent Review Office's pages on how claims are managed, understanding your claim, getting legal advice (ILARS) and contacting the IRO, on 23 October 2026. The State Insurance Regulatory Authority's website and the NSW legislation website could not be read that day.