The NSW scheme.In plain language.

Also called biopsychosocial model

An approach to recovery and injury management that considers interacting biological, psychological, behavioural, social and economic factors, alongside functional evidence and the worker’s strengths and circumstances.

Also called case conferencing · doctor case conference

A meeting in person, by video or by phone among some or all of the worker, employer, insurer, nominated treating doctor, rehabilitation provider and treating practitioners to coordinate recovery and suitable work. It is separate from a medical consultation unless the worker and doctor agree otherwise.

Also called category one employer

An employer with a basic tariff premium over $50,000 a year, a self-insurer, or an employer insured by a specialised insurer with more than 20 workers. Category 1 employers must appoint a return-to-work coordinator and maintain a tailored return-to-work program.

Also called category two employer

Any employer that does not meet the Category 1 criteria. It must still have a return-to-work program and nominate someone responsible for workers compensation and recovery-at-work activity.

Also called medical certificate · workers compensation certificate

The approved certificate, usually completed by the worker’s nominated treating doctor, that describes the injury, present capacity for work and treatment needed for recovery. It also provides evidence relevant to weekly-payment entitlement.

Also called commutation agreement · lump sum settlement

An agreed lump sum that removes the insurer’s liability for specified future weekly payments and/or medical, hospital and rehabilitation expenses. Strict eligibility, independent legal advice, SIRA certification and PIC registration requirements apply.

Also called CWE · actual weekly earnings

For a worker injured on or after 21 October 2019, generally the greater of the worker’s actual gross earnings for the week and the amount they are able to earn in suitable employment. Earlier injuries may be governed by different provisions.

Also called some work capacity · partial capacity

A present inability caused by the injury where the worker can return to pre-injury or suitable employment but can earn less than before the injury. Different statutory wording may apply to workers injured before 21 October 2019.

Also called 42-day determination period

The 42-day period beginning when the insurer receives a completed relevant-conduct claim. If the insurer does not accept or dispute liability within that period, the claim is taken to have been accepted.

Also called excessive workload

Demands beyond those expected of the worker’s role that are repeated or persistent and not reasonable in all the circumstances. Ordinary pressure or a heavy workload does not automatically satisfy this statutory definition.

Also called fear-avoidance

Concern that movement, activity or work may cause harm or re-injury, which can contribute to avoiding activity. Explore it respectfully with the worker and treating team; do not use it as a judgement about motivation.

Also called weeks 1 to 13 · first 13 weeks

The first 13 aggregate weeks for which weekly compensation is payable. The calculation depends on PIAWE, current earnings, work capacity and the statutory maximum.

Also called ILARS · IRO legal funding

The IRO-administered service that can fund approved lawyers to advise and represent eligible injured workers in compensation matters and disputes. Funding is subject to eligibility and a grant; it is not automatic.

Also called IME · independent medical assessment

An assessment by an appropriately qualified and experienced independent medical practitioner to help resolve a defined injury-management or claims-management issue. It is not treatment.

Also called IRO

The independent statutory office that assists injured workers with enquiries and complaints about workers compensation insurers. IRO also administers ILARS but does not itself give legal advice.

Also called initial notification · injury notification

The first notification of an injury received by the insurer in the form required by the Workers Compensation Guidelines. For a primary psychological injury first notified to the employer on or after 1 July 2026 and covered by the reforms, the notification must identify at least one relevant-event type; a relevant-conduct claim then follows the special completed-claim pathway.

Also called IMC

A registered doctor experienced in occupational injury and workplace rehabilitation who facilitates agreement and helps overcome recovery-at-work barriers. The IMC does not decide liability or direct the worker’s treatment.

Also called IMP

A written plan developed by the insurer in consultation with the worker and relevant stakeholders. It records the actions each party will take to support treatment, recovery and return to work.

Also called workers compensation insurer

A general scheme term covering the Workers Compensation Nominal Insurer, self-insurers, specialised insurers and government self-insurers. The insurer manages claims, makes entitlement decisions and coordinates injury-management obligations within its authority.

Also called interim weekly payments · interim entitlements

Temporary weekly payments available while a completed relevant-conduct claim is being determined. They generally equal 75% of PIAWE less current weekly earnings where applicable, subject to the statutory maximum, and must start within seven days. Limited medical or related treatment is also available without deciding final liability.

Also called insurer review · review of insurer decision

An insurer’s reconsideration of a decision, generally available as an optional step before an ordinary PIC dispute. Under the mandatory pathway for a relevant-conduct dispute, the review must be conducted by an appropriately experienced, more senior decision-maker who was not substantially involved in the original decision before the dispute proceeds to the IRC or PIC.

Also called MMI · stable condition

The point at which a worker’s condition is well stabilised and unlikely to change substantially during the next year, with or without treatment. It is relevant to when permanent impairment can be reliably assessed.

Also called statutory maximum · weekly payment cap

The statutory ceiling on weekly compensation under section 34 of the Workers Compensation Act 1987. It is indexed, so the current amount should always be checked in SIRA’s live benefits guide.

Also called MAC

The certificate in which a PIC medical assessor records their decision and reasons on a medical dispute. A permanent-impairment assessment in a MAC is binding subject to the available appeal process.

Also called PIC medical assessor

An independent medical practitioner appointed to assess medical questions referred by the Personal Injury Commission. A medical assessor decides the referred medical issues but does not provide treatment or clinical advice to the worker.

Also called minimum information · complete conduct claim

The prescribed information needed with the claim form before a relevant-conduct claim is complete. It includes party and treating-practitioner details, a medical certificate specifying a disorder, consent, relevant proceeding details and, as far as practicable, particulars of the alleged conduct and its employment connection.

Also called no work capacity · unfit for work

A present inability caused by the injury that prevents the worker from returning to either pre-injury employment or suitable employment.

Also called NI · icare Nominal Insurer

The workers compensation Nominal Insurer established under section 154A of the Workers Compensation Act 1987. icare acts for the Nominal Insurer, which provides insurance to most NSW businesses and contracts claims service providers to manage claims.

Also called NTD · treating doctor

The treating medical practitioner nominated by the worker for the purposes of their injury management plan under section 42 of the Workplace Injury Management and Workers Compensation Act 1998. Usually the worker’s GP, the NTD assesses and treats the injury, describes work capacity and supports recovery at work.

Also called section 66 compensation · non-economic loss · lump sum compensation

A statutory lump-sum benefit for qualifying permanent impairment resulting from a work injury. Eligibility depends on the injury type, assessed impairment and applicable threshold; it is separate from weekly payments and treatment expenses.

Also called PIC · the Commission

The independent NSW statutory tribunal that resolves workers compensation and motor-accident disputes. Workers compensation matters can follow legal, medical, expedited or damages pathways.

Also called pre-injury earnings decision

An insurer’s decision about the amount of a worker’s pre-injury average weekly earnings. Decisions made from 1 July 2026 are not work-capacity decisions, although insurer review and Personal Injury Commission dispute pathways remain available.

Also called PIAWE · pre-injury earnings

The earnings amount used to calculate weekly compensation. For workers injured on or after 21 October 2019, it generally represents the weekly average of gross earnings from every employment held at the time of injury. Different rules apply to earlier injuries and some worker cohorts.

Also called pre-reform assessment

The most recent impairment assessment or agreement made before 1 July 2026 and relied on to determine weekly payments, lump-sum compensation or work injury damages. It is treated as the worker’s principal assessment under the new system. If impairment was assessed or agreed before 1 July 2026 but the worker has not claimed section 66 lump-sum compensation, the claim must be made before 1 July 2028.

Also called primary psych injury

A psychological injury that is not secondary to a physical injury. For injuries first notified on or after 1 July 2026, compensation generally requires a relevant event, a real and direct employment connection and employment as the main contributing factor.

Also called principal permanent impairment assessment

The principal assessment of the worker’s degree of permanent impairment for all relevant injuries, used to determine multiple compensation entitlements. For workers covered by the reforms, transitional arrangements apply from 1 July 2026 to mid-2027 and the worker must obtain independent legal advice before assessment. The reforms do not apply to exempt workers, coal miners, volunteers, dust-disease claims or injuries received before 1 January 2002.

Also called graduated return to work · staged return to work

A planned progression towards pre-injury duties as capacity and workplace risk allow. Changes may involve hours, tasks, pace or supports and should be agreed with the worker and reviewed against current capacity advice.

Also called provisional acceptance · provisional payments

A mechanism allowing an insurer to make early payments before formally deciding claim liability. It can provide up to 12 weeks of weekly payments and up to $10,000 for reasonably necessary medical treatment, without admitting final liability. It does not apply to a relevant conduct claim for a primary psychological injury first notified to the employer on or after 1 July 2026 and covered by the reforms; that pathway uses interim entitlements instead.

Also called mental injury · psychiatric injury

An injury that is a mental or psychiatric disorder causing behavioural, cognitive or psychological dysfunction. For most primary psychological injuries first notified on or after 1 July 2026, compensation also requires a relevant event, a real and direct connection with employment, and employment to be the main contributing factor. Different rules apply to excluded cohorts, secondary injuries and earlier notifications.

Also called delay provisional payments

A reason permitted by the Workers Compensation Guidelines for an insurer not to begin ordinary provisional payments within seven days of initial notification. It cannot be used for a relevant-conduct claim concerning a primary psychological injury first notified to the employer on or after 1 July 2026 and covered by the reforms.

Also called return to work plan · RTW plan · suitable duties plan

A worker-specific written plan setting out work goals, duties, hours, workplace adjustments, responsibilities and review dates. It is distinct from the employer’s general return-to-work program and the insurer’s injury management plan.

Also called conduct claim

The subgroup of relevant events consisting of bullying, sexual harassment, racial harassment and excessive work demands. A claim arising from relevant conduct follows the special completed-claim, interim-entitlement and dispute pathway introduced from 1 July 2026.

Also called psychological injury relevant event

A legally specified event capable of supporting a primary psychological injury first notified to the employer on or after 1 July 2026 and covered by the reforms. Categories include violence, indictable criminal conduct, witnessing specified trauma, a qualifying death in care, vicarious trauma and relevant conduct; each has a defined legal test.

Also called relevant injury · relevant conduct claim

A primary psychological injury caused by being subjected to relevant conduct. Compensation begins only when the insurer receives the completed claim form and prescribed minimum information, subject to the claim’s later acceptance or deemed acceptance.

Also called RTW Coordinator · RTW coordinator

A person employed or engaged by an employer to implement its return-to-work program, support workers to recover at work and link each worker with their support team. Category 1 employers must appoint a coordinator with relevant training, skills and experience.

Also called RTW program · workplace return to work program

An employer’s formal policy and procedures for responding to work-related injury and supporting recovery. Every NSW employer must establish a program that aligns with its insurer’s injury management program and SIRA’s guidelines.

Also called recovery barriers · return to work barriers

Personal, workplace, healthcare, insurance and system factors that may delay recovery or return to work. They should be identified collaboratively and addressed through tailored, person-centred support rather than assumptions about a worker’s motivation.

Also called weeks 14 to 130 · second payment period

The next 117 aggregate entitlement weeks, covering weeks 14 to 130. Payment calculations vary according to work capacity, earnings and hours worked.

Also called secondary psych injury

A psychological injury arising as a consequence of, or secondary to, a physical injury. The new primary-psychological-injury reforms, including the relevant-event requirements, do not apply to secondary psychological injuries.

Also called reasonable management action · section 11A defence

For a primary psychological injury first notified to the employer on or after 1 July 2026 and covered by the reforms, section 11A of the Workers Compensation Act 1987 provides that no compensation is payable if the significant cause was reasonable management action taken or proposed by the employer, or the worker’s expectation or perception of that action. The action must be reasonable and taken in a reasonable way. Earlier notifications, secondary psychological injuries and excluded cohorts may instead be subject to the earlier test that the injury was wholly or predominantly caused by specified reasonable employment action.

Also called section 39B · additional 52 weeks

A post-130-week pathway for qualifying new primary psychological injuries in the intermediate impairment band. Up to 52 further weeks may be available subject to the applicable WPI band, work-capacity, hours and current indexed-earnings tests, which change over time.

Also called section 78 notice · decision notice

Written notice an insurer must provide when disputing liability or discontinuing or reducing weekly payments. It must explain the decision, its effect, review rights and available assistance; a special approved form applies to relevant-conduct liability decisions from 1 July 2026.

Also called self insurer · self-insurance

An employer licensed by SIRA to manage its own workers compensation liabilities and claims for covered workers, subject to the licence and scheme requirements.

Also called significant workplace injury

A workplace injury expected to cause total or partial incapacity for work for a continuous period of more than seven days. A significant injury activates particular injury-management obligations.

Also called workplace rehabilitation provider · WRP · rehabilitation consultant

A SIRA-approved organisation whose appropriately qualified staff provide specialised workplace rehabilitation services. They may assess workplace and functional needs, identify suitable work, address recovery barriers and recommend workplace modifications. The insurer engages and pays the provider after consulting the worker.

Also called specialised workers compensation insurer

A licensed insurer whose restricted licence allows it to provide workers compensation insurance for a specific industry or class of employers.

Also called SIRA · the Authority

The NSW regulator for workers compensation, compulsory third party motor accidents and home building compensation schemes. SIRA sets requirements, supervises scheme participants and publishes guidance and data.

Also called suitable duties · modified duties

Work matched to the worker’s current capacity. When an employer provides suitable work, it should, as far as reasonably practicable, be the same as or equivalent to the worker’s pre-injury employment and may involve changed hours, duties, training or another workplace.

Also called further impairment assessment · condition deterioration

For workers and claims covered by the 2026 permanent-impairment reforms, this is the limited route to a further assessment where the worker and insurer agree the condition appears unexpectedly and materially worse. There must have been no reasonable cause at the previous assessment to expect the deterioration, it must increase permanent impairment by at least 10 percentage points, and age-related deterioration is excluded.

Also called WPI · permanent impairment percentage

A percentage measure of permanent impairment assessed under the applicable NSW evaluation guidelines. WPI can affect weekly-payment duration, medical entitlements, lump-sum compensation, commutations and work injury damages; applicable thresholds depend on the injury, notification date and benefit.

Also called work capacity evaluation · section 44A assessment

An insurer’s assessment of an injured worker’s current work capacity under section 44A of the Workers Compensation Act 1987 and the Workers Compensation Guidelines. It may use existing evidence or require further information and is distinct from a functional capacity evaluation.

Also called WCD · capacity decision

An insurer decision about matters such as current work capacity, suitable employment, earning capacity or another matter affecting weekly payments. From 1 July 2026, a decision about PIAWE is treated separately and is no longer a work-capacity decision.

Also called common law damages · modified common law damages

Modified common-law damages for past economic loss and future loss of earning capacity where the work injury resulted from employer negligence or another applicable tort. Impairment thresholds and other preconditions apply, including staged thresholds for new primary psychological injuries.

Also called high needs worker

Generally, a worker whose injury has resulted in more than 20% permanent impairment, or who satisfies one of the statutory pending-assessment or likely-impairment alternatives. The definition includes a worker with highest needs.

Also called highest needs worker

Generally, a worker whose injury has resulted in more than 30% permanent impairment, or who satisfies one of the statutory pending-assessment or likely-impairment alternatives. Special weekly-payment and medical-entitlement provisions can apply.