Form · Personal Injury & Compensation

Review form (SIRA): ask the insurer to review a work capacity or liability decision

Link to SIRA's review form. It includes the 14-day insurer review and the stay of weekly payments.

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 sira.nsw.gov.au and the 2 authorities it cites, for New South Wales.
Version: 1
Source: Link to the official form. Licence: © State Insurance Regulatory Authority. Link only: download the current form from SIRA each time. Do not copy or adapt it.

Where this comes from

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

When to use it

Use when a worker asks the insurer to review a work capacity decision, or a decision to dispute liability for a workers compensation claim or any aspect of a claim, made on or after 1 March 2021. The worker may write to the insurer instead of using the form.

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 decision notice, the date it takes effect and the documents already on the file, and it writes nothing in the worker's declaration.

AI may

Extract the decision date, the date the decision takes effect, and whether the notice is a work capacity decision or a liability dispute
List the attachments the worker already holds that respond to the reasons in the notice
Calculate the 14th day after [DATE OF APPLICATION] from the date the application is sent

AI must not

Must not write section 6, the worker's declaration
Must not argue the review or describe the injury in words the worker has not confirmed
Must not advise the worker to wait for the insurer's review before lodging in the Personal Injury Commission
Must not sign or send the form

The lawyer checks

The decision was made on or after 1 March 2021. The form is marked effective that date, catalogue SIRA08989, copyright 0221
The insurer must use a different staff member and must complete the review and notify the outcome within 14 days of the application
The worker may lodge a Personal Injury Commission dispute at any time and need not wait for the review
Stay: if a work capacity dispute is lodged with the Commission before the date the decision takes effect, the form says weekly payments do not change until the Commission determines the dispute
Independent Review Office 13 94 76 and www.iro.nsw.gov.au for approved lawyers. Interpreter 13 14 50
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 Insurance Regulatory Authority. Link only: download the current form from SIRA each time. Do not copy or adapt it..

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