You can contact IRO if you have a complaint about an insurer that affects your entitlements, rights or obligations under NSW workers’ compensation legislation of the NSW motor accident compensation legislation. This includes complaints about: weekly benefits, medical treatment, denials of liability and delays in determining claims.
No. IRO can only deal with complaints from injured persons in the NSW workers compensation system or the NSW motor accident compensation system. We are unable to deal with complaints from claimants in interstate compensation systems, workers whose employers are insured under Comcare. These workers should call Comcare on 1300 366 979.
Please ask yourself these questions before giving IRO a call:
Have you provided a current Certificate of Capacity to your Insurer? Have you provided your payslip if you are working? Have you confirmed with the insurer that they have received the above information? Has it been 5 working days since this information has been received by the insurer?
If you answered yes to these questions, contact us and we can contact the insurer for you
Talk to your case manager first, they will be able to explain how your weekly benefits are calculated. If you still think you aren’t being paid correctly, contact us and we can contact the insurer and review how your weekly benefits have been calculated.
Try sending your case manager an email and cc the insurer’s generic mailbox address, call the general number for the insurer or log your complaint online. If you still don’t get a response contact us and we can contact the insurer for you.
Work capacity assessments ascertain a worker’s ability to return to work following an injury in the workplace. The assessment by the insurer is a review of the worker’s function, vocational and medical status. In conducting a work capacity assessment consideration will be given to all available information including:
medical reports from your treating doctor or specialist certificates of capacity
independent medical reports
Injury Management Plans
reports from a workplace rehabilitation provider such as workplace assessment reports, return to work plans, functional capacity evaluation reports, vocational assessment reports, work trial documents, job seeking logs, activities of daily living assessments, etc
information provided by the worker about their abilities.
You must attend and participate in any evaluation required as part of the work capacity assessment.
Once you have been assessed, the insurer will make a work capacity decision. This decision is based on:
a worker's current work capacity what constitutes suitable employment for a worker
the amount an injured worker is able to earn in suitable employment
the amount of pre injury average weekly earnings or current weekly earnings
whether a worker is, as a result of injury, unable without substantial risk of further injury to engage in employment of a certain kind because of the nature of that employment
any other decision that affects a worker’s entitlement to weekly payments of compensation, including a decision to suspend, discontinue or reduce weekly payments of compensation based on the points above.
Work capacity decisions will be made at many points throughout the life of a worker’s claim, for example on receipt of new information relating to the worker’s capacity for employment.
It depends on when and how your claim was closed. Should your circumstances change after your claim was closed and you believe you are entitled to reopen your claim for treatment, you should notify the insurer with the relevant information from your nominated treating doctor.
The insurer then has 21 days to make a liability decision for workers compensation, or 10 days to make a decision if it is a motor accident claim. If the insurer has not made a decision within the applicable time, please contact us.
If you wish to access any financial support available from the Australian or NSW Government you will need to discuss your circumstances with the agency managing the support package, for example, Service NSW or Services Australia.
To ensure that those agencies understand your circumstances, you will need to inform them about your entitlement for workers compensation weekly payments.
If you do obtain any of these supports, you should advise your workers compensation insurer.
The COVID-19 Disaster Payment is a weekly payment available for individuals in Commonwealth-declared hotspots where restrictions lasting for more than seven days have caused reduced work hours or lost income.
COVID-19 Disaster Payments are not considered earnings for the purpose of determining your pre-injury average weekly earnings or when determining the weekly compensation payment to which you are entitled.
For workers compensation matters, IRO operates the Independent Legal Assistance and Review Service (ILARS). Find a lawyer near youto access free, independent legal advice from one of our approved lawyers.