Who is eligible to make a workers insurance claim

As the nominal insurer for workers insurance in NSW, we cover all types of work related injuries.

To be covered by workers insurance following a workplace injury or illness, you will need to provide medical evidence that indicates it was sustained as a result of your employment.

There are different types of claims a worker can make following a workplace incident. Different types of claims have different eligibility criteria. For example if you are claiming lump sum compensation for permanent impairment arising out of a psychological injury you need to be assessed as having a permanent impairment of 15% or more. However if you were claiming lump sum compensation for a physical injury you need to be assessed as having a permanent impairment of more than 10%.

Claims for injuries that occurred during a work journey or on a work break have different eligibility criteria as well.

All other workplace injury claims will be assessed on a case by case basis.

Learn more about making a claim

Who can make a claim

If you’re injured at work, it’s important to notify your employer as soon as possible.

Your employer will contact the insurer to notify them of your injury, and may start the claims process on your behalf. Your employer should provide you with the insurers contact details at this time. 

You can also lodge a claim with the insurer if your employer has not yet done so.

Your nominated treating doctor will play a vital role throughout your recovery. They are responsible for providing a certificate of capacity that determines if you are able to work, what types of duties you may be able to perform to enable recovery at work and what kind of treatment you need.

To make a claim, the following information will need to be provided:

  • Evidence you were employed
  • A certificate of capacity indicating that you sustained an injury or illness from or during your employment
  • Documentation that you require medical treatment, you have lost income or you have incurred expenses as a result of the injury or illness. This can include any bills or receipts incurred since your injury.

Time limits for making a claim

You should make a claim as soon as possible to make sure the right support is provided for your recovery.

A claim can be made within six months of the date of injury or accident.

If your injury or illness arises after your employment has finished, you may still be covered under workers insurance. Your injury must still be related to your employment.

This is particularly common with injuries that have a delayed onset, such as hearing impairment claims and permanent impairment.

If you are unsure, please get in touch with us to discuss your situation.

Contact us

Types of claims we cover

A workplace injury or illness may be physical or psychological in nature.

When describing your diagnosis, your doctor should only use accepted medical terminology on the certificate of capacity.

There are different types of claims that have specific eligibility criteria:

  1. Claims for medical treatment and rehabilitation expenses
  2. Claims for weekly payments
  3. Claims for psychological injury
  4. Permanent impairment
  5. Work break and journey injuries
  6. Hearing impairment

When making a claim, medical evidence is required to indicate that you suffer from an injury or illness as a result of your employment.

Learn more about making an injury claim

Severe workplace injuries

If you have sustained a severe injury in a NSW workplace and have an accepted workers insurance claim, you may be eligible for the workers care program.

Severe injuries can include:

  • brain injury
  • spinal cord injury
  • amputations
  • burns
  • permanent blindness. 

Generally, your case manager at the insurance agent who manages your workers insurance claim will contact us if they think your injury will meet the criteria for the workers care program. If your injury meets the criteria, we’ll contact you to let you know. We’ll also assign you a workers care coordinator who will be your main point of contact and coordinate your injury-related services. 

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