Prefer to Listen? Play this quick summary instead!
Being told your workers comp claim is rejected in NSW can be stressful, especially when you are already dealing with treatment and time away from work.
Now, if your workers comp claim is rejected, the insurer should explain its decision in writing. This must include the reasons and information about review rights. A rejected claim is not necessarily the end of the process. Depending on the type of dispute, you may be able to request an insurer review, contact the Independent Review Office (IRO), or apply to the Personal Injury Commission (PIC).
What happens if my workers comp claim is rejected in NSW?
A rejected claim is an insurer’s decision based on the information available to it. The insurer should explain the decision in writing and provide information about your review rights. You may be able to ask the insurer to review the decision, seek help from the IRO, or take the dispute to the PIC, depending on the issue. (SIRA)
“Your claim decision and your recovery are two separate problems. AusRehab helps you keep the second one moving while the first is worked through.”
What It Means When Your Workers' Comp Claim Is Rejected
When a workers’ compensation claim is declined, the insurer is deciding that it does not accept liability based on the information it has considered. The decision should be explained to you in writing, including the reasons and available review or dispute options.
- You should receive a written decision notice:
If the insurer declines liability, the notice should explain the reasons for the decision and tell you about your available options. This is where a Section 78 notice NSW may apply.
- The insurer may consider different issues:
Depending on your claim, this may include whether it was reported and lodged within the required timeframe, whether your employment substantially contributed to the injury, and whether the treatment or expense is reasonably necessary.
- A declined decision can be challenged:
A workers compensation decision notice does not necessarily end the matter. If you disagree with the decision, review and dispute options are available in NSW.
⚠️ What is a Section 78 notice?
A Section 78 notice is a formal written notice about an insurer’s decision. It explains the effect of the decision, the reasons and information about your rights to seek a review.
Common Reasons a Workers' Comp Claim Is Rejected
There is no single reason why workers’ compensation claims get denied. The insurer’s decision depends on the facts and evidence available for that claim.
Some common reasons identified by SIRA include questions about whether someone is a worker under the legislation or whether employment substantially contributed to the injury. It could also be about whether particular treatment or expenses are reasonably necessary.
| Reason a Claim May Be Declined | What It Generally Means |
|---|---|
| You are not considered a worker under the legislation | The insurer considers your working arrangement to fall outside the legal definition of a worker |
| Your employment did not substantially contribute to the injury | The insurer accepts there is an injury but disputes that your employment was a substantial contributing factor |
| The treatment or expense is not reasonably necessary | The insurer disputes whether a particular treatment or cost is reasonably necessary for the injury |
Remember, a rejected claim may involve different issues, depending on the insurer’s assessment of your circumstances and the evidence provided.
📌 Quick Tip
If treatment has been declined, ask your treating provider to explain what treatment is being recommended, why it is needed, and how it relates to your injury.
Rejected Claim vs Payments Stopped After Approval
A workers comp claim rejection decision is different from having an accepted claim where payments are later reduced or stopped.
Now, for example, a work capacity decision in NSW may affect weekly payments even though the claim itself has already been accepted. SIRA’s decision notice requirements cover decisions to discontinue or reduce weekly compensation payments.
What to Do First if Your Claim Is Rejected
If you are wondering what to do if a workers’ compensation claim is denied, start with the decision itself. Do not ignore the notice or wait until the problem becomes more difficult to resolve.
Your First Steps, in Order
1. Read the decision notice
Look for the exact reason your claim was declined and any information about review or dispute options.
2. Ask questions if something is unclear
You can contact the insurer if you do not understand the decision or need clarification about the information they considered.
3. Gather relevant information
Collect information that directly responds to the reason for the decision. Depending on the issue, this could include medical information or other supporting documents.
4. Request a review where appropriate
NSW insurers have an internal review process. SIRA states that a worker can request the insurer to review its decision and provide additional information.
5. Keep track of timeframes
Do not assume you can wait indefinitely. The insurer must respond to a review request in writing within 14 days, either overturning, modifying or maintaining the original decision.
6. Get independent help if needed
The IRO can help workers understand their options and complaints about insurers. It may also help eligible workers access legal assistance through ILARS.
If you are wondering what to do if a workers’ compensation claim is denied, start with the decision itself. Do not ignore the notice or wait until the problem becomes more difficult to resolve.
📌 Quick Tip
Keep your decision notice, medical documents, emails and other claim correspondence together. Having one clear record can make it easier to explain what has happened.
💡Fact: SIRA states that an insurer must respond to a workers’ compensation review request in writing within 14 days. The response must say whether the original decision has been overturned, modified or maintained.
Free Help When Your Claim Is Rejected: IRO and ILARS
⚠️ Can I get a workers compensation lawyer for free in NSW?
You do not have to navigate a dispute alone. The Independent Review Office (IRO) is free and independent and can help with complaints and disputes. If legal help is needed, the IRO may connect you with a lawyer through the Independent Legal Assistance and Review Service (ILARS), which can apply for funding to help resolve the dispute.
The Independent Review Office (IRO)
If you disagree with your insurer or are unsure about what to do next, the IRO can help you understand the available options. The IRO does not replace the insurer or make every claim decision itself. Its role includes helping workers resolve complaints and understand their rights and options.
How to contact the IRO
You can contact the IRO on 13 94 76 or through its online services.
The Independent Legal Assistance and Review Service (ILARS)
An ILARS lawyer can assess your matter and may apply for funding to help resolve the dispute, including through the Personal Injury Commission where appropriate. An IRO-approved lawyer can provide legal advice and, where funding is available, assist with a dispute.
💡 What is ILARS?
ILARS stands for the Independent Legal Assistance and Review Service. It is a service through which eligible injured workers may receive funded legal assistance for workers compensation matters.
Taking a Rejected Claim to the Personal Injury Commission
The Personal Injury Commission workers’ compensation pathway can be used for certain disputes between workers and insurers. If you disagree with an insurer’s decision, you may have the right to lodge an application with the PIC. The Commission deals with different types of workers’ compensation disputes, but not every dispute follows the same process.
The PIC can deal with disputes involving areas such as:
- Weekly compensation.
- Medical and related expenses.
- Work capacity decisions.
- Permanent impairment compensation.
- Other workers compensation entitlements.
The appropriate pathway depends on the type of decision and dispute.
💡 How to contact the PIC?
The Personal Injury Commission can be contacted on 1800 742 679 between 8:30 am and 5:00 pm, Monday to Friday (excluding public holidays).
Paying for Treatment While Your Claim Is Disputed
⚠️ Who pays for treatment if my workers’ comp claim is rejected?
If your claim is declined, workers’ compensation funding for treatment may no longer be available, but that does not always mean treatment has to stop. Depending on your circumstances, there may be other ways to cover costs while the claim is disputed. Each option has its own eligibility rules, so check with the relevant provider.
| Option to Explore | What to Check |
|---|---|
| Private health insurance | Whether any of your treatment costs may be covered under your policy |
| Superannuation cover | Whether your fund includes sickness, accident or other relevant cover. |
| Public health system | Talk to your GP about treatment options available through the public system. |
| Third-party insurance | If the injury is connected with a motor vehicle accident, ask about relevant third-party options. |
| Other health support | If you are experiencing a psychological or psychiatric condition , ask your GP about a mental health treatment plan or other support. |
These options have different rules and eligibility requirements. Check before assuming a particular cost will be covered.
📌 Quick Tip
If your treatment has been affected by the claim decision, tell your treating team promptly. They can help you understand what treatment is clinically appropriate while you work through the next steps.
What to Do if You Cannot Work After a Rejected Claim?
A rejected claim can create uncertainty about both treatment and income. If you cannot return to your normal job, speak with your doctor about your current capacity. Your doctor may be able to explain whether you can safely perform some duties. You can also discuss suitable duties after workers’ comp claim is denied with your employer if you have some capacity to work.
The options available will depend on the worker’s circumstances and the cover or entitlements they have.
- Talk to your doctor about your current capacity for work and whether there are duties you may still be able to manage.
- Ask your employer about any leave entitlements that may be available to you.
- Discuss whether suitable, lighter or different duties could be available if you have some capacity to work.
- If you have income protection insurance, contact your insurer and check whether your superannuation fund includes sickness or accident cover.
- Ask your insurer whether any programs or services may still be available after the claim has ended.
How AusRehab Helps When Your Claim Is Rejected
A disputed claim can affect more than the claim itself. It can also make treatment, communication and return-to-work planning harder. AusRehab can support rehabilitation during workers compensation dispute by keeping the focus on recovery, capacity and practical workplace planning.
| What AusRehab Can Do | What AusRehab Cannot Do |
|---|---|
| Keep clear, consistent records of your injury, work capacity, treatment and progress | Overturn an insurer decision or require an insurer to fund treatment |
| Support communication between you, your GP, employer and insurer | Provide legal advice or represent you in a dispute |
| Help you understand what the decision may mean for treatment, rehabilitation and return to work planning | Decide questions of liability, which sit within the review and dispute process |
| Point you towards appropriate independent services, including the IRO | Guarantee an outcome or a back payment |
| Explore suitable duties with your employer if and when you have capacity | Replace the insurer, the IRO, ILARS or the PIC |
| Keep your rehabilitation plan focused on recovery while the claim is worked through |
AusRehab can support your recovery, rehabilitation and return-to-work planning. Decisions about liability, disputes and compensation sit with the relevant insurer and independent authorities.
📌 Note:
AusRehab does not decide whether a claim should be accepted or rejected. We also do not provide legal representation. Legal questions about a disputed workers compensation claim should be directed to an appropriate legal adviser or independent service such as the IRO.
2026 Update: Rejected Psychological Injury Claims
Workers’ compensation changes for some psychological injury claims took effect from 1 July 2026.
The changes apply to primary psychological injuries notified from that date. New rules include different requirements around relevant events and relevant conduct.
Relevant conduct includes:
- Bullying.
- Sexual harassment.
- Racial harassment.
- Excessive work demands.
For certain claims involving relevant conduct, the process is different. If the insurer disputes whether the conduct is relevant conduct, the Industrial Relations Commission has a new role in determining that issue. The worker must generally request an insurer review before the relevant dispute can proceed to the PIC or IRC for determination.
What Happens if Your Rejected Claim Is Later Accepted?
If a rejected claim is later accepted, the entitlements that become payable will depend on the claim, the period in dispute and the final decision. Do not assume that every previous cost or payment will automatically be covered.
If you are asking what happens if a rejected workers’ comp claim is later accepted, check the final decision carefully. You can also seek help from the insurer, IRO or an ILARS lawyer to understand what the decision means for your particular circumstances.
Key Takeaways:
- A workers comp claim rejection decision in NSW should be explained to you in writing.
- Read the decision carefully and identify the exact reason for the rejection.
- Common issues include worker status, the connection between employment and injury, and whether treatment is reasonably necessary.
- You may be able to request a review by the insurer.
- The IRO provides independent help with insurer complaints and can assist eligible workers with access to legal help through ILARS.
- The Personal Injury Commission deals with many workers’ compensation disputes.
- Treatment and return-to-work planning may need to continue through other arrangements while a claim is disputed.
- AusRehab can support rehabilitation and return-to-work planning but does not provide legal representation.
Take the Next Step With Your Claim and Recovery
A rejected claim can leave you unsure about what happens next. You do not have to put your recovery on hold while you work through the process.
If you need support with workplace rehabilitation, work capacity or return-to-work planning, speak with the AusRehab team. We can help keep your recovery organised while you access the appropriate independent support for the claim itself.
Speak to the AusRehab team about rehabilitation and return-to-work support after a rejected workers’ compensation claim.
Frequently Asked Questions (FAQs)
Do I have to ask the insurer for an internal review before going to the Personal Injury Commission?
For many disputes, you do not have to request an internal review first, and you may be able to apply to the PIC directly. Some 2026 relevant-conduct psychological injury claims are an exception. If you are unsure, the IRO can help you understand which pathway applies.
How long does the insurer have to respond to a review request?
The current SIRA guidelines specify that the company that is assessing the claimant’s application is obliged to reply to a review request in writing within 14 days.
Is there a time limit to challenge a rejected workers comp claim in NSW?
This will depend on the type of dispute involved. It’s always better to act as soon as possible so that you have time to get legal advice from the IRO, ensuring that you do not miss anything important in your specific case.
Does a pre-existing condition automatically disqualify my claim?
No. While having a pre-existing injury may play a factor in your claim, it is not the only factor. Moreover, each claim stands on its own merit, including whether your work played a role in the condition. If this was indeed the case, more medical information may be required for further investigation.
Can my employer dismiss me while my workers' comp claim is rejected or disputed?
This question is dependent on your personal situation, as it is a matter outside the actual claim and is therefore dependent on the law. If you are concerned, contact the IRO for advice on how to proceed.
If my claim is later accepted, are my past treatment costs covered?
This relies on the final verdict in your case and whether or not you are entitled to compensation during the disputed period. Do not presume every cost has a direct link to the insurance company. Always check with the insurer, IRO, or ILARS attorney about your case status.
Can I still see my treating doctor if my claim has been rejected?
Yes. A rejected claim does not hinder you from seeing your treating doctor. In fact, keeping your treating physician updated may help if you decide to have the decision reviewed.
Can AusRehab help even if my claim has already been rejected?
Yes, AusRehab cannot reverse the decision in question, but can help keep your records, work capacity, suitable duties and return to work planning organised while you work through the claim process.
⚠️ Disclaimer: General educational information from AusRehab, current as of September 2026. It is not legal or medical advice. Workers’ compensation outcomes depend on your circumstances and the rules that apply to your claim. For advice about a dispute, speak with the IRO or an appropriate legal adviser.
