Workers compensation in NSW

The nominated treating doctor

Where a work injury stops someone doing their normal job for seven days or more, they must nominate a treating doctor. It is the worker’s right and responsibility to choose that doctor, and to choose one who is prepared to take part in their recovery and return to work.

The nominated treating doctor explains the injury and the recovery options, recommends treatment, acts as the main point of contact for information about treatment and capacity, helps develop the injury management plan with the insurer and employer, reviews progress and capacity regularly, and completes the certificate of capacity.

A worker can change their nominated treating doctor. Accepted reasons include the doctor relocating, or evidence that the current management is not helping recovery and a safe return to work. The insurer and employer must be told about the change.

The certificate of capacity

This is the central document. It records the diagnosis and the date of injury, the planned treatment, and — most consequentially — how the injury affects the person’s ability to do their normal activities including work.

Two rules commonly catch people out. A certificate should generally not exceed 28 days, and cannot be issued for longer without specific reasons being given. And a certificate cannot cover a period more than 90 days before the date it is completed, so backdating has limits.

The first certificate is completed by the nominated treating doctor, who assesses the worker’s full health needs. Second and subsequent certificates may in some circumstances be issued by an approved treating physiotherapist or psychologist within their scope.

Signing the certificate is also how a worker authorises information about their injury to be shared for the injury management plan. It is worth reading rather than signing automatically.

Making a claim, and the timeframes

Urgent treatment comes first. After that, the worker must tell their employer as soon as possible. The employer must report the injury to their insurer within 48 hours of becoming aware of it.

The insurer should make contact within three business days and provide a claim number. A claim should generally be lodged within six months of the injury, though extensions are possible — up to three years in some circumstances, and beyond that with approval.

If an employer does not notify the insurer, the worker can contact the insurer directly rather than waiting.

Capacity, suitable duties and recovering at work

Capacity is not a yes-or-no question, and the certificate is not a choice between fit and unfit. It records what someone can do — hours, tasks, weights, postures — which is the information an employer needs to offer something workable.

The evidence behind this is reasonably strong. Most injured workers take little or no time off, and of those who do, more than 80 per cent return to and recover at work within the first 13 weeks. The longer someone is away from work, the less likely they are ever to return. Staying active reduces pain symptoms and shortens recovery, and an increase in pain during recovery does not always mean further damage.

Suitable duties can mean the same job with different hours, modified duties, a different job altogether, a training opportunity, work at another site, or a combination. The most useful thing a worker can bring to an appointment is a position description or list of duties — and a willingness to talk about what they can do, not only what they cannot.

Who is involved

The employer must, where possible, provide suitable work that matches the worker’s capacity. The insurer’s case manager coordinates the claim. The nominated treating doctor assesses capacity and supports recovery. A workplace rehabilitation provider may be engaged to address physical, functional, psychological or workplace barriers — paid for by the insurer, and the worker should be consulted about the choice and may request a change.

Treatment approval

Most treatment needs insurer approval before it is provided, but there are exceptions that matter in the early weeks. Treatment within the first 48 hours of injury, emergency department care within a month, consultations with the nominated treating doctor within a month, and prescribed medicines do not require pre-approval. Nor do specialist referrals and imaging within set windows, or an initial course of up to eight sessions with an approved allied health practitioner within three months of injury.

Insurers must determine treatment requests as soon as possible and within 21 days at most. For allied health requests made within three months of injury, the insurer must respond within five working days — and if it does not, the request is automatically approved.

If treatment is declined, the insurer must issue a dispute notice. That is not the end of the matter.

Psychological injury claims changed in 2026

NSW workers compensation legislation was substantially amended, with the main changes commencing on 1 July 2026. Injuries notified before that date continue under the previous rules, so when the injury was notified now determines which framework applies.

For psychological injury, the changes are significant. A primary psychological injury must arise from a defined relevant event — such as violence or threats, witnessing a traumatic incident, vicarious trauma, bullying, harassment, or excessive work demands — have a real and direct connection to employment, and have employment as the main contributing factor. Reasonable management action taken in a reasonable way, such as performance management or a transfer, remains a defence available to employers.

Claims involving bullying, harassment or excessive demands now follow a distinct process with a 42-day insurer decision period, interim weekly payments beginning within seven days, a cap on medical treatment during that period, and a mandatory internal review before dispute resolution. Whole person impairment thresholds for continuing benefits have also risen.

These are genuine restrictions on access, and this page cannot tell anyone whether their claim will succeed. Anyone with a psychological injury claim in NSW should get independent advice early.

Where to get independent help

The Independent Review Office resolves complaints about insurers and funds expert lawyers to assist injured workers through its legal assistance service, which is free to the worker. It can be reached on 13 94 76.

For other complaints, SIRA can be contacted on 13 74 72. The usual order is to raise the issue with the insurer’s case manager first, then the Independent Review Office, then SIRA. Unions, the Personal Injury Commission and the NSW Ombudsman are also available depending on the issue.

What to bring to an appointment

A position description or list of duties, and details of your usual hours and shift pattern. The claim number if one has been issued, and the insurer or case manager’s name. Details of how the injury happened. Any imaging or specialist reports already obtained. A list of current medicines. And any previous injuries to the same area, which are relevant whether or not they were work related.