Do you need a workers compensation lawyer?
Most claims don't. If you disagree with a decision on your claim, you can ask for a review, and the Independent Review Office (IRO) can fund an approved lawyer. Call us and we'll tell you where you stand.
We go through the decision with you and explain the review steps in plain English. Most WorkCover disputes qualify for IRO funding, which usually means the legal costs aren't yours. If a decision needs reviewing, or your claim reaches the lump-sum stage, we put you in touch with a compensation lawyer.
When a workers compensation lawyer helps
Most claims don't need a lawyer at all. When one helps, it's usually for one of four reasons.
A well-run NSW workers comp claim looks like this: you get hurt, you see a WorkCover doctor, the certificate goes in, the insurer accepts liability inside three weeks, your weekly payments arrive on time, your treatment is authorised, and you return to work in a graduated way. Most claims follow that path without a lawyer. When a decision goes the other way, it's usually one of four things.
The first trigger is denial of liability— the insurer decides the injury isn't work-related, or that the worker isn't entitled under the Act. The second is a change to your weekly payments— a work capacity decision reduces or stops them, or the week-13 step-down (from 95% to 80% of PIAWE) doesn't look right. The third is a treatment decision — the insurer declines a request for surgery, ongoing physio or a specialist referral. The fourth is the lump-sum stage.
The lump-sum stage is where the amounts are largest and where advice matters most. Once your injury has stabilised, you may be able to claim a Section 66 lump sum for permanent impairment, and with a more serious injury, work injury damages. A compensation lawyer can tell you whether, and when, an impairment assessment makes sense.
What a lawyer costs you (usually nothing)
Most WorkCover disputes qualify for IRO funding, which usually means the legal costs aren't yours.
The Independent Review Office (IRO) is a statutory body funded by the NSW workers compensation scheme. Its mandate includes paying the legal costs of approved lawyers who take on disputed workers compensation matters under the Workers Compensation Act 1987 (NSW). The funding is allocated case-by-case through what's called an "ILARS grant" (Independent Legal Assistance and Review Service), and it covers the lawyer's fees, the medical-legal reports the lawyer arranges, and the disbursements, through to the Personal Injury Commission if needed. IRO also gives workers free, independent help and takes complaints about how a claim is being handled.
In practice: at the first consultation, the lawyer looks at the decision and either applies to IRO for an ILARS grant, or tells you plainly that a dispute isn't worth pursuing. If the grant is approved, it funds the lawyer's costs, so they don't come out of your weekly payments or your lump sum. Ask the lawyer to confirm the funding before you start.
The exception is work injury damages — a separate common-law claim for a more serious injury (15% WPI or more for a physical injury; a higher threshold applies to a primary psychological injury) where negligence by the employer can be shown. Work injury damages sit outside ILARS funding, so the lawyer explains their own fee terms before you agree to anything.
For how we help if you disagree with a decision, see our WorkCover compensation lawyer page.
The decisions people most often ask about
These are the decisions people most often call us about. Each one can be reviewed, and the steps are well set out.
"We don't think it's work-related"
The insurer accepts you're injured but not the link to work — common with repetitive-strain claims, mental health claims, and aggravation of pre-existing conditions. On a review, the full medical picture from your treating doctor matters most.
"You're fit for suitable employment"
An independent medical examiner's opinion on your capacity differs from your treating doctor's, and your weekly payments or duties change as a result. If you disagree, you can ask for a review, and your treating doctor's view of your capacity is part of the picture.
"Treatment isn't reasonably necessary"
Surgery, ongoing physio, psychology sessions or specialist referrals declined as "not reasonably necessary" under s 60. You can ask for the decision to be reviewed, and a report from your treating doctor explaining why the treatment is needed helps.
Weekly payments after week 130
After week 130, weekly payments continue only if you meet the continuation tests in the Act, and they stop at week 260 unless your whole person impairment is more than 20%. A primary psychological injury has its own thresholds. If a decision about your payments after week 130 doesn't look right, you can ask for it to be reviewed.
Section 66 lump-sum dispute
You and the insurer don't agree on your whole person impairment percentage. The Personal Injury Commission can refer the question to an independent medical assessor. A few percentage points can make a real difference to the lump sum.
Work-injury damages (common law)
For a physical injury assessed at 15% WPI or more (25% for a primary psychological injury from 1 July 2026, rising in later years), where employer negligence can be shown. Damages cover economic loss only, and electing them ends future statutory benefits, so legal advice matters here.
From first call to resolution
If you disagree with a decision, these are the usual steps, in the scheme's own order.
Ask the insurer for an internal review
If you disagree with a decision, the first step is usually to ask the insurer to review it. The decision letter tells you how, and the time limit that applies. Call us and we'll go through the letter with you.
Free help from the Independent Review Office
The Independent Review Office (IRO) gives free, independent help to injured workers, and takes complaints about how a claim is being handled.
A lawyer, funded through ILARS
If the dispute needs legal advice, an approved lawyer applies to IRO for an ILARS grant to fund their costs, including the medical-legal reports the lawyer arranges. We put you in touch with a compensation lawyer if you need one.
The Personal Injury Commission (PIC)
If the dispute isn't resolved, it can go to the Personal Injury Commission, which decides workers compensation disputes. Conciliation comes first, then arbitration or a medical assessment if no agreement is reached.
A decision
Timing depends on the dispute. Lump-sum and work injury damages matters can take longer because of medical assessments. If you have a lawyer, they keep you informed at each step.
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If your claim has been denied, your payments reduced, or you're approaching the lump-sum stage — one phone call tells you where you stand.
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