---
title: "Review form (SIRA): ask the insurer to review a work capacity or liability decision"
url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-insurer-review"
type: "precedent"
site: "AI Law Framework"
id: "a21-form-nsw-sira-insurer-review"
area_id: "A21"
kind: "form"
ai_level: "yellow"
version: 1
task_ids: ["A21-WR20261022-10", "A21-T1-R13", "A21-B5-6"]
law_stated_as_at: "2026-10-23"
---

# 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.

Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-insurer-review  
Law stated as at: 2026-10-23

Site index for agents: https://ailawframework.com/llms.txt

## Key facts

- Kind: Form. A form to complete, or a guide to completing an official one.
- Practice area: [Personal Injury & Compensation](https://ailawframework.com/precedents/personal-injury-and-compensation.md)
- Jurisdictions: New South Wales
- AI level: Yellow. You and the tool draft together, with you directing. You check every statement you rely on.
- Law stated as at: 2026-10-23
- Status: Maintained. Checked on 2026-10-23 against the official form at sira.nsw.gov.au and the 2 authorities it cites, for New South Wales.

## 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

- [Record the time to ask for reconsideration of a compensation determination](https://ailawframework.com/practice/personal-injury-and-compensation/record-the-time-to-ask-for-reconsideration-of-a-compensation-determinati.md)
- [Draft correspondence to the insurer or scheme agent](https://ailawframework.com/practice/personal-injury-and-compensation/draft-correspondence-to-the-insurer-or-scheme-agent.md)
- [Prepare a CTP or workers compensation dispute submission from the scheme file](https://ailawframework.com/practice/personal-injury-and-compensation/prepare-a-ctp-or-workers-compensation-dispute-submission-from-the-scheme.md)

## 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).

## Authorities

- [State Insurance Regulatory Authority, Review form – application for review by the insurer (effective 1 March 2021, catalogue SIRA08989)](https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/440447/Review-form-application-for-review-by-the-insurer.pdf)
- [State Insurance Regulatory Authority, Workers compensation forms](https://www.sira.nsw.gov.au/resources-library/workers-compensation/forms)

## Official form

[Official form](https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/440447/Review-form-application-for-review-by-the-insurer.pdf)

## 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.

## Full text and drafting notes

The full text and the drafting notes are not part of this public page. Signed-in firm accounts can read them at https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-insurer-review and through the signed-in MCP connector https://ailawframework.com/mcp/firm.

*Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*