Form · Personal Injury & Compensation

Form 5C: commutation determination for a legally incapacitated worker

Link to the Personal Injury Commission's Form 5C for a commutation determination where the worker is legally incapacitated, including the SIRA certificate the form requires.

Kind: Form. A form to complete, or a guide to completing an official one.
Where it applies: New South Wales
AI use: Yellow You and the tool draft together, with you directing. You check every statement you rely on.
Law stated as at: 23 October 2026
Status: Maintained. Checked on 23 October 2026 against the official form at pi.nsw.gov.au and the 2 authorities it cites, for New South Wales.
Version: 1
Source: Link to the official form. Licence: © State of New South Wales (Personal Injury Commission). Link only: use the current Commission form. Do not copy or adapt it.

Where this comes from

The official form is published by pi.nsw.gov.au; this page is a completion guide. Last checked on 2026-10-23.

When to use it

Use when asking the Personal Injury Commission to determine a commutation of liability under the Workers Compensation Act 1987 for a worker who is legally incapacitated. Where the worker is not legally incapacitated, the form says to use Form 5A.

Used for these tasks

Each task page says how far AI may help with the task and what the lawyer must review.

How AI may be used

The tool may list the documents the form asks to attach and the office named on the instrument of appointment, and it writes nothing in the signed application.

AI may

List whether a SIRA certification, the instrument of appointment and the medical material are on the file
Record the office title exactly as it appears on the instrument of appointment
Extract the lump sum figure proposed in a draft only where that figure is already written on the file

AI must not

Must not write the signed application or describe the worker's capacity
Must not replace the form's names Public Trustee, Protective Commissioner or Protected Estates Act 1983 with later office names
Must not decide that the worker is legally incapacitated or that a commutation should be made
Must not lodge the form

The lawyer checks

The worker is legally incapacitated. If not, the form says use Form 5A. Form 5A was not opened
SIRA certification under section 87EA is attached before the Commission can determine the application. The form says section 87G is the determination power
The form still names the Public Trustee, the Protective Commissioner, and a financial manager appointed under the Protected Estates Act 1983. Quote the form. Do not translate those names
The form notes that if liability is only partially commuted, section 87I(1) means the balance continues to be payable under the Workers Compensation Act 1987
Hand delivery is Level 21, 1 Oxford Street, Darlinghurst NSW 2010. Postal address is PO Box 594, Darlinghurst NSW 1300
Court approval for a protected person is a separate question from lodging this form
Health, wage and other personal information stays in a firm-controlled tool. Check confidentiality under ASCR r 9 and APP 11, and whether any breach is notifiable under the Privacy Act 1988 (Cth).

Method: how the Green, Yellow and Red levels are decided. This is guidance for planning, not legal advice.

Authorities

Official form

Open the official form. Always use the current version from the issuer. Licence: © State of New South Wales (Personal Injury Commission). Link only: use the current Commission form. Do not copy or adapt it..

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