Form · Personal Injury & Compensation

Worker's injury claim form (SIRA): weekly payments and treatment expenses

Link to SIRA's worker's injury claim form for weekly payments and treatment costs, with the sections every claim needs, the signed declaration, and the certificate of capacity to send with it.

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 in NSW claims weekly payments or medical, hospital and rehabilitation expenses for a work injury. Tell the employer and obtain a certificate of capacity or medical certificate before the form is sent.

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 check the draft against the current form and list missing sections from facts already on the file, and it writes nothing in the worker's declaration or the worker's account of the injury.

AI may

List which of sections 1, 2, 3, 4, 5, 7, 8 and 9 are still incomplete on a draft assembled from the file
Note whether section 6 and earnings evidence are needed because the file records time off work
Index the certificate of capacity, payslips, receipts and other attachments by date and author

AI must not

Must not write section 9, the declaration and authority to release medical information, or any account of how the injury happened
Must not sign or send the form to the employer or the insurer
Must not describe a primary psychological injury or choose the form's relevant events
Must not put health or wage information into a tool that is not firm-controlled

The lawyer checks

The form in use is the current SIRA form. The PDF opened on 23 October 2026 is marked effective 20 October 2026
The worker has told the employer and a certificate of capacity or medical certificate is attached
Section 6 and earnings evidence are included where there has been time off work
The worker signs section 9 before the form is sent to the employer or the employer's insurer
The forms index warns that content may change as reforms are implemented
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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