The NSW Personal Injury Commission ('The Commission') is an independent and impartial body set up to help resolve disputes between people injured in motor accidents or at work, and their insurers or employers. The Commission aims to handle cases fairly, quickly, and affordably, with minimal formalities. An application to resolve a dispute can be lodged by, or on behalf of, an injured person, an insurer or an employer.
Understanding the terms below:
- Dispute: A disagreement about a decision made by an insurer or employer, such as whether you should receive compensation or medical treatment for an injury.
- Complaint: A concern about how the Commission’s staff treated you or how they handled your case. Complaints focus on improving the service but don’t change the decision about your dispute.
What types of disputes can you lodge?
Workers Compensation: You can dispute decisions regarding your compensation for workplace injuries. These include:
- Legal Disputes: Disputes about entitlement to compensation, such as weekly compensation, medical expenses, lump sum compensation for permanent impairment, and death benefits.
- Medical Disputes: Disagreements about the extent of a work injury and the necessity of medical treatments. An independent Medical Assessor evaluates the injury and provides a report to help settle the dispute.
- Expedited Assessment: Fast-track review requests if decisions on claims are delayed, claims are not accepted, or there's disagreement about compensation amounts, ability to work, or injury management.
- Damages Disputes: Seeking compensation for injuries due to unsafe workplace conditions, requiring proof of 15% permanent impairment and prior receipt of lump sum payments.
- Other Disputes: Miscellaneous applications for various issues, such as compensation for workers living overseas, temporary compensation awards, interest payments, sharing medical reports, reimbursement requests, and legal cost coverage.
Motor Accidents – 2017 Scheme: You can dispute decisions about motor vehicle accident claims for accidents occurring on or after 1 December 2017. Common complaint types include:
- Miscellaneous Claims Assessment: Disputes about issues such as establishing the identity of a motor vehicle, determining the at-fault insurer, fault determination, entitlement to statutory benefits, and compliance with verification requirements.
- Claims for Damages Assessment: Assessments for compensation due to car accident injuries, determining the extent of injuries, fault, and appropriate compensation amounts.
- Merit Review Dispute: Requests for the Commission to review decisions about weekly benefits, funeral expenses, treatment costs, rehabilitation, vocational training, and legal costs.
- Medical Dispute: Disputes about medical decisions related to degree of impairment, necessity of treatment, treatment relevance to the accident, treatment impact on recovery, and impairment of earning capacity.
Motor Accidents – 1999 Scheme: For accidents occurring on or before 30 November 2017, you can dispute decisions about claims. Common dispute types include:
- Special Assessment: Disputes about issues like filing late claims, not reporting accidents to the police, compliance with claim rules, specific payments, insurer delays, and hardship situations.
- Claims for Damages: Seeking compensation for expenses like medical bills and lost wages, with a six-month filing requirement.
- Medical Dispute: Disputes about the severity of injuries and the necessity of treatments.
Police Officer Support Scheme: or disputes between injured police officers and the NSWPolice Force relating to claims lodged from 27th September 2024.
Complaints about the Commission
- Staff Behaviour/Commission Service: Complaints about staff or decision-makers' behaviour, aiming to improve service and maintain trust. These complaints won't alter Commission decisions.
Jurisdiction:
The Commission resolves disputes within NSW.
Time Limitations:
Time limits may apply to lodging an application once the insurer’s decision is made. Different divisions within the Commission may have different time limits.
The Commission will not deal with disputes about:
The Commission only manages disputes about the workers compensation, motor accidents and police officer support schemes. Other disputes are excluded.
Who can you lodge a dispute against?
- You can lodge a dispute against anyone involved in a case under the workers compensation, motor accidents, or police officer support schemes.
- You can lodge a complaint against the commission staff or decision-makers: For complaints about behaviour or service.
Are you eligible?
Who can lodge a dispute?
Anyone involved in the case or their legal representative.
Who can complaint?
Any injured person over 18, or their representative.
Before you lodge a complaint:
- Workers’ Compensation Division: Submit a claim to the employer’s workers’ compensation insurer first.
- Motor Accidents Division: The decision must have been subject to an internal review by the insurer.
Additional Information:
The Commission’s services are free, and legal representation is not required, though you can seek legal advice.
What can this body do to help?
This body may provide:
- Arbitration: Decision by a registrar or Presidential member.
- Mediation and Conciliation: Facilitate negotiations to reach a resolution.
- Formal Arbitration: Formal hearings for unresolved disputes.
- Damages Assessment: Assess appropriate compensation amounts.
- Review and Reconsideration: Review and reconsider decisions.
- Recommendations and Non-Binding Decisions: Suggest courses of action.
- Referrals to Other Agencies: Refer cases outside its jurisdiction.
How to prepare your dispute or complaint
Format:
- Disputes should be lodged using the Commission’s online digital platform, Pathway, except for matters under the Police Officer Support Scheme which are lodged via email using the relevant application form. Ensure you provide all information required as outlined on the Personal Injury Commission website.
- Complaints about staff or service can be written or oral.
What NOT to Include:
False or misleading statements.
Lodging your complaint and next steps:
Where to Lodge:
- Disputes: Online portal at Commission’s online portal. If self-represented or unable to use the portal, contact the Commission for alternatives.
- Complaints about Staff or Service: In writing to the Principal Registrar, through the online form, by calling 1800 742 679, or by mail to: PO Box 594 Darlinghurst, NSW 1300.
Next Steps:
- The respondent insurer must respond within 14 or 21 days from the date the application was registered.
- The matter will progress based on the Commission's directions and the type of complaint.
More information:
Refer to the factsheet provided below for more information.
