NSW WC - Claims Management

Claims Management

In NSW insurance agents provide policy and claims management services in the NSW workers compensation scheme.

Allianz is committed to providing you with the highest level of care and courtesy. To assist you, Allianz has outlined our service promise and how you can contact us.

Please see our Customer Service & Complaints Management Model

PIAWE and Weekly Benefits

Calculating pre-injury weekly earnings (PIAWE) and weekly benefits is complex. To provide a clearer understanding, and to help simplify the PIAWE process, the following resources are available:

Please contact your Case Manager or Business Account Manager if you have any questions

Claim lifecycle – what happens and when

The table below shows the typical lifecycle of a workers compensation claim. This table is a simple description of the claims process, so you know what to expect if you need to make a claim.

Step 1. (Worker step)A workplace injury is reported to the employer.
Step 2. (Employer step)The employer notifies Allianz within 48 hours of the injury/incident and is issued a claim number.

Phone: 1300 360 595 (Allianz First Report)
Fax in NSW: 02 9390 6633

Email: firstreport@allianz.com.au
Internet: On-line lodgement of a claim notification

Important note: please quote the claim number along with the workers’ name and date of injury on all future claims correspondence. Making a claim

Notifying icare
In the case that a serious incident occurs known as a “notifiable incident” you must notify icare on 13 10 50 immediately, further details below:

A "notifiable incident" under the work health and safety legislation relates to:
  • the death of a person
  • a serious injury or illness of a person
  • a potentially dangerous incident

Significant penalties apply if you fail to notify an incident.
Step 3. (Allianz step)An Allianz case manager will contact the employer, worker and the nominated treating doctor to assess the claim and ensure the injury management program has commenced. From this information our case manager will assess if there is sufficient information to accept the claim under ‘Provisional Liability’. If there is insufficient information to make a decision about the claim, the case manager will notify of a ‘Reasonable Excuse’ and what actions Allianz and the worker can take to provide better particulars to enable to decision on liability.
Step 4. (Allianz step)Provisional Liability payments commence. Allianz will notify both parties to advise of the value of payments to be made to the worker and for how long. Provisional Liability enables Allianz to make available compensation for income support and medical treatment without an admission of liability. Allianz will continue to gather particulars on the claim, and where necessary make a decision about liability if payments are to exceed the provisional liability period that is capped at 12 weeks of wages payment and/or $7500 in medical expenses.
Step 5. (Employer step)The worker and employer complete and return a Workers’ Compensation Claim Form together with a WorkCover Medical Certificate.
Step 6. (Allianz step)Allianz determines liability within 21 days of receipt of a completed Workers’ Compensation Claim Form.
Step 7. (Allianz step)Liability accepted
The Allianz case manager collaborates with the worker, employer and healthcare professional to return the worker to health and work as soon as possible.

Liability not accepted
The Allianz case manager will notify the employer and worker of the liability decision in writing.
Step 8. (Worker step)Allianz will provide the necessary support to assist the worker to return to work and health. When the worker is declared fit for work. All accounts / wage reimbursements sent to Allianz for payment.
Step 9. (Allianz step)Allianz closes the claim.

Further Assistance

Register of injuries

All employers are responsible for maintaining a Register of Injuries. A Register of Injuries is a current record of any injuries suffered by workers, whether they result in a claim or not. Employers are required to keep a Register of Injuries that is readily accessible in the workplace. A standard register of injuries book with standard forms is available from Allianz on 1300 130 664 (Monday to Friday: 8:30am to 5pm) or the SIRA Customer Service Centre on 13 10 50 (Monday to Friday: 9am to 5pm).

Customer Service and Complaints Management Model

Allianz strives to deliver superior customer service by treating our customers with courtesy and respect, while responding promptly, with empathy, honesty and professionalism. We aim to understand our customers’ needs and go above and beyond expectations in our commitment to service delivery. Please refer to our Customer Service and Complaints Management Model for more information.

Further assistance

If you are unsatisfied with your experience please contact Allianz in the first instance. If you are unsatisfied with the resolution provided and require further assistance with your Claim or notice, you can contact SIRA’s Customer Service Centre on 13 10 50, your union legal representative, or the Workers Compensation Independent Review Office (WIRO) on 13 94 76. The WorkCover Independent Review Office (WIRO) provides an independent complaints solution service for Workers who are unhappy with a decision made by their insurer. WIRO also provides funding for legal advice. For more information or to make a complaint, call WIRO on 13 94 76 or visit their website.

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Dispute resolution

A Workers Compensation Commission (WCC) has been established, providing a single organisation that helps parties come to an agreement about a dispute or, when needed, will make a decision about a dispute. The WCC deals with all disputes arising out of workers' compensation claims made on or after 1 January 2002. The WCC can determine the following:

  • Interim Payment Directions – The Commission can order interim weekly compensation payments for limited periods, and for payment of medical expenses (up to $7500).
  • Weekly benefits paid as compensation for loss of earnings.
  • Medical and related expenses
  • Permanent impairment / pain and suffering (approved medical specialists will form part of the WCC and will deal with medical disputes by the issue of a Medical Assessment Certificate. The Certificate will be conclusive in the event of a permanent impairment claim).
  • Compensation for the death of a worker
  • Management of a worker's injury or illness in the workplace (suitable duties).
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