--- title: "Permanent impairment claim form (SIRA): lump sum workers compensation" url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-permanent-impairment-claim" type: "precedent" site: "AI Law Framework" id: "a21-form-nsw-sira-permanent-impairment-claim" area_id: "A21" kind: "form" ai_level: "yellow" version: 1 task_ids: ["A21-B8-2", "A21-WR20261022-1", "A21-T1-R4"] law_stated_as_at: "2026-10-23" --- # Permanent impairment claim form (SIRA): lump sum workers compensation > Link to SIRA's permanent impairment claim form, with the form's own threshold words set beside the 11% and 15% figures on SIRA's current permanent impairment page. Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-permanent-impairment-claim 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 3 authorities it cites, for New South Wales. ## When to use it Use when a worker in NSW claims lump sum compensation for permanent impairment after maximum medical improvement. Check the current Act and SIRA's permanent impairment page before the form is sent. The 2019 PDF and that page do not use the same percentage. ## Used for these tasks - [Summarise medical reports for a whole-person impairment assessment](https://ailawframework.com/practice/personal-injury-and-compensation/summarise-medical-reports-for-a-whole-person-impairment-assessment.md) - [Test an injury against the statutory threshold for benefits or damages](https://ailawframework.com/practice/personal-injury-and-compensation/test-an-injury-against-the-statutory-threshold-for-benefits-or-damages.md) - [Map statutory entitlements under the applicable compensation scheme](https://ailawframework.com/practice/personal-injury-and-compensation/map-statutory-entitlements-under-the-applicable-compensation-scheme.md) ## How AI may be used The tool may index the assessor's report and list the attachments the form asks for, and it writes nothing in the declaration and does not state the percentage threshold as settled. **AI may:** - Index the permanent impairment report by assessor, body system, date and the percentage stated in that report - List whether a worker's injury claim form, an audiogram, or a pre-2002 report is on the file - Record the dates on the form PDF and on the SIRA permanent impairment page so the two threshold wordings can be compared **AI must not:** - Must not write section 8, the worker's declaration, or the worker's account of the injury - Must not treat the PDF's words 'more than 10%' as the threshold in force - Must not decide maximum medical improvement, whole person impairment, or whether a further claim is available - Must not sign or send the claim **The lawyer checks:** - Check the current Act. The PDF (catalogue SIRA08797, copyright 0119) says the claim can only be made where maximum medical improvement has been reached and the degree of permanent impairment is more than 10% - The SIRA page opened on 23 October 2026 says a lump sum claim made on or after 19 June 2012 requires 11% or more for a physical injury, or 15% or more for a primary psychological injury - That page says permanent impairment compensation is not available for secondary psychological injuries, and that there is one claim per injury, with a possible further claim if a claim was made before 19 June 2012 and the condition deteriorated - The report is from a SIRA-listed assessor trained in the body system where the injury is on or after 1 January 2002, or supports the loss claimed where the injury is before that date - Hearing loss: the audiogram is attached and section 6 of the form is used - Insurer times on the SIRA page: one month to accept and offer or to dispute, and the two-week and two-month extensions if more information or an examination is required - 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, Permanent impairment claim form (catalogue SIRA08797, copyright 0119)](https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08797-Permanent-impairment-claim-0119.pdf) - [State Insurance Regulatory Authority, Permanent impairment (page opened 23 October 2026)](https://www.sira.nsw.gov.au/workers-compensation/what-you-can-claim/permanent-impairment) - [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/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08797-Permanent-impairment-claim-0119.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-permanent-impairment-claim 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.*