NSW Workers Compensation: icare Claims, SIRA and Weekly Payments

NSW workers compensation is run by icare as the scheme's insurer and SIRA as its regulator, with a strict six-month deadline to lodge most claims and a system currently being reshaped by a major 2025-2026 legislative reform.

Scheme name and who runs what

NSW workers compensation has run on a three-agency model since September 2015, when the old WorkCover NSW was abolished and split. icare (Insurance and Care NSW) is the scheme's insurer, operating the Workers Compensation Nominal Insurer, branded Workers Insurance, for private-sector employers, and managing the Treasury Managed Fund for most public-sector employers. icare doesn't process most claims day to day itself; it contracts five Claims Service Providers, EML, Allianz, GIO, Gallagher Bassett and QBE, to manage claims on its behalf. SIRA (State Insurance Regulatory Authority) regulates the workers compensation insurance scheme, alongside CTP motor accidents. SafeWork NSW is the independent workplace health and safety regulator, a separate body from both icare and SIRA.

icare is the brand name most people actually search for, "icare claim" or "icare workers comp." SIRA is the body a worker is more often told to escalate a complaint to.

For how NSW fits into the wider national picture, including Comcare and cross-border work, see our Australia workers compensation guide.

Who is covered

NSW workers compensation is a no-fault system. A worker doesn't need to prove employer wrongdoing, only that the injury is work-related and that employment was a substantial contributing factor. Standard employees are covered automatically.

Certain non-employee categories are "deemed workers" for compensation purposes even where they may be contractors for tax purposes, including outworkers, commission-paid salespeople, canvassers and collectors, labour-hire contractors, rural workers, and boxers, wrestlers, referees and entertainers, under Schedule 1 of the Workplace Injury Management and Workers Compensation Act 1998. Ordinary contractors are not covered unless deemed. icare applies a multi-factor test: a contractor is more likely to use their own skill and judgment, employ or sub-contract others, quote for the job, and supply their own tools, while a worker is more likely to be directed on how and when work is done, paid on a time basis, supplied with tools, and working exclusively for one employer. An ABN alone does not decide the question, and tax status "bears no direct relationship" to workers compensation status.

Volunteers and unpaid work-experience students are not "workers" under the Workers Compensation Act 1987 and are not covered by a workers compensation policy, though the organisation may still owe them a general duty of care. Employers must keep documentation supporting a decision not to cover a contractor who could be a deemed worker for five years.

After an injury: reporting and claim deadlines

The general process: seek first aid or medical attention and notify the employer as soon as possible. The employer must then notify its Claims Service Provider within 48 hours of being told of the injury. If the employer doesn't, the worker, or a nominated representative such as a family member or doctor, can lodge directly through icare's online injury-notification form. The insurer must review the claim within 3 business days and complete a full assessment within 7 days. A workers compensation certificate of capacity, usually completed by the worker's nominated treating doctor, is needed to keep receiving weekly payments and treatment, and generally covers up to 28 days unless the Claims Service Provider agrees otherwise.

The claim time limit itself is six months from the injury, or from the date of death for a death claim, confirmed in near-identical language by both icare and the Independent Review Office, an independent NSW statutory office. If there is a reasonable cause for missing the six-month window, such as ignorance, genuine mistake, or absence from NSW, a claim can still be made up to three years after the injury. A claim for an injury that resulted in death or serious and permanent disablement, with reasonable excuse for the delay, can be made even beyond three years. Any claim outside the three-year window otherwise generally needs SIRA's approval. This deadline is separate from Australia's general civil statute of limitations rules, which don't apply to a workers compensation claim in the same way they apply to a lawsuit.

Two payment mechanisms bridge the gap while a claim is being assessed. For general and physical injury claims, and for traumatic-event psychological claims notified before 1 July 2026, the insurer can start provisional payments within 7 days of notification, up to 12 weeks of weekly payments plus up to $10,000 in medical expenses, none of it repayable if the claim is later declined. For psychological injury claims arising from "relevant conduct," bullying, racial harassment, sexual harassment, or excessive work demands, notified on or after 1 July 2026, a new interim entitlement payment covers 75 percent of pre-injury average weekly earnings for up to 56 days, also not repayable if declined, plus up to $7,500 in related medical treatment.

Weekly payments

The maximum weekly payment was $2,604.80 for 1 October 2025 to 31 March 2026. It was historically re-indexed twice a year, but under the 2025-2026 reform the general maximum moves to annual indexation each 1 April, so no further October update should be expected. Confirm the current figure with icare before relying on it.

Duration caps differ by injury type. A primary physical injury has a 260-week (5-year) cap. A primary psychological injury notified on or after 1 July 2026 has a shorter 130-week (2.5-year) cap, a new limit introduced by the 2025-2026 reform; pre-reform psychological claims used the same 260-week structure as physical claims. Workers with a whole person impairment above 20 percent are exempt from the automatic cutoff; the earning-and-hours conditions that apply to other workers are waived for them. Under the 2026 reform, psychological-injury workers with impairment of at least 21 percent may also get a further 52 weeks of weekly and medical entitlements (icare has not published the applicable payment rate for this extension), even where they fall under the extended-benefits threshold.

Workers injured before 21 October 2019 remain on an older stepped structure tied to a percentage of pre-injury average weekly earnings, still described on icare's current pages. Exempt workers, police officers, paramedics, firefighters, volunteer bush firefighters and rescue volunteers, get a different formula entirely: the full current wage rate for the first 26 weeks (100 percent of the applicable award rate, or 80 percent of average weekly earnings where no award applies), then the statutory rate after that.

Medical and treatment

Coverage extends to medical and related treatment, some hospital treatment, ambulance costs, workplace rehabilitation services, and travel expenses. The 2025-2026 reform raises the legal test for medical and treatment entitlement from 'reasonably necessary' to 'reasonable and necessary,' a higher standard, for new requests once that change takes effect on 1 October 2026. For psychological injury claims under the reform, reasonable and necessary treatment is covered for 12 months after weekly benefits end, extended further for workers with the highest needs, impairment above 30 percent whole person impairment. An employer or its representative may not attend a worker's medical treatment or examination unless the worker specifically requests it, a new reform protection. The reform also removes an older exclusion that had barred lump-sum compensation where impairment resulted from voluntary sexual activity or illicit drug use in HIV or AIDS cases.

Permanent impairment lump sums

The psychological injury lump sum threshold is a whole person impairment of at least 15 percent, confirmed unchanged by the reform; the Personal Injury Commission has stated directly that there is no change to this threshold. The physical injury lump sum threshold is commonly reported as above 10 percent whole person impairment, but recordinglaw could not independently verify that specific figure against a SIRA source directly, since SIRA's website could not be reached during research for this page. Confirm the current physical-injury threshold with icare or SIRA before relying on it.

The 2025-2026 reform introduces a "single principal assessment" model. Historically, workers could get separate impairment assessments for different entitlements over time. Now, one principal assessment determines eligibility for weekly benefits, medical expenses, the lump sum, commutations and work injury damages together. A second assessment is only allowed for an unexpected and material deterioration of at least 10 whole-person-impairment points. Assessments made before 1 July 2026 can be grandfathered as the principal assessment, but affected workers must lodge a lump-sum claim before 1 July 2028. Before an assessment can start, the insurer must confirm the worker received independent legal advice, that the condition is linked to the injury, and that the worker has reached maximum medical improvement; the insurer can no longer direct a worker to attend an assessment, that choice now sits with the worker and their lawyer.

Work injury damages: the common-law pathway

NSW's name for a common-law damages claim is "work injury damages." To bring one, a worker generally needs employer negligence, and permanent impairment of at least 15 percent whole person impairment, the general threshold for a physical injury. The statutory lump sum must be exhausted or paid first before a work injury damages claim can settle, and a settlement cancels further weekly and medical entitlements for that injury, with prior weekly payments already made repaid out of the settlement.

The psychological-injury work injury damages threshold is being raised in stages by the 2025-2026 reform, applying only to injuries notified or claimed after each relevant date; pre-reform notifications keep the 15 percent threshold.

• At least 25 percent whole person impairment for injuries notified or claimed on or after 1 July 2026.
• At least 27 percent whole person impairment for injuries notified or claimed on or after 1 July 2027 (stated as "more than 26 percent" in statutory-style wording and "27% WPI" in icare's plain-language pages, the same threshold, since impairment is assessed only in whole percentage points).
• At least 28 percent whole person impairment for injuries notified or claimed on or after 1 July 2029, a figure every source checked for this page agrees on.

Because the applicable threshold depends on when the injury was notified rather than when someone reads this page, a worker near one of these dates should confirm the exact date that applies to their own claim with icare or a lawyer.

Disputes: the Personal Injury Commission

The Personal Injury Commission replaced the former Workers Compensation Commission and SIRA's Dispute Resolution Service on 1 March 2021, under the Personal Injury Commission Act 2020. It handles legal disputes, medical disputes, expedited assessments, damages disputes and other workers compensation disputes through a digital case-management portal. The 2025-2026 reform expands its role further: the Commission now approves commutations, previously a SIRA function, can settle disputed lump-sum death benefit claims by compromise (except coal-mining matters, which stay with the District Court), can appoint tutors for workers under legal incapacity, and can restrict publication of certain decisions. The Independent Review Office sits alongside the Commission; it doesn't decide disputes itself but funds and approves lawyers for injured workers through grants, and handles complaints against insurers.

As of the research for this page, the Personal Injury Commission's own website noted that its workers compensation information was being updated to reflect the recent reforms, so some procedural detail may still be settling in.

Employer obligations and return to work

Employers must notify their Claims Service Provider within 48 hours of learning of an injury, and maintain a register of injuries, name, address, age, occupation, industry, date and time, and the nature and cause of the injury, even for injuries that never become a claim. The register must be kept somewhere readily accessible in the workplace, and penalties apply for failing to keep one. Employers must also develop a return to work plan in consultation with the worker and their nominated treating doctor.

Under the reform, for a policy issued or renewed on or after 4pm on 30 June 2026, employers must pay a fixed excess equal to the weekly compensation for the first week the worker's entitlement exceeds zero, plus the following week. This excess doesn't apply to journey claims, recess claims, small employers with annual wages of $7,500 or less, domestic or similar-worker policies, or exempt workers such as police, paramedics and firefighters. The reform also increases penalties for underinsurance, non-insurance, and failing to provide suitable work. A dismissal connected to a workers compensation claim may separately raise a general protections issue under federal employment law, which sits outside the workers compensation system entirely.

Other states run genuinely different schemes: see our guides to Victoria workers compensation and Queensland workers compensation.