---
title: "Worker's injury claim form (SIRA): weekly payments and treatment expenses"
url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-workers-injury-claim"
type: "precedent"
site: "AI Law Framework"
id: "a21-form-nsw-sira-workers-injury-claim"
area_id: "A21"
kind: "form"
ai_level: "yellow"
version: 1
task_ids: ["A21-T1-R5", "A21-T1-R15", "A21-A20260923-1"]
law_stated_as_at: "2026-10-23"
---

# 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.

Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-nsw-sira-workers-injury-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 2 authorities it cites, for New South Wales.

## 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

- [Draft the pre-action notice or statutory claim form from the instructions](https://ailawframework.com/practice/personal-injury-and-compensation/draft-the-pre-action-notice-or-statutory-claim-form-from-the-instruction.md)
- [Triage a new injury enquiry against scheme eligibility](https://ailawframework.com/practice/personal-injury-and-compensation/triage-a-new-injury-enquiry-against-scheme-eligibility.md)
- [Reconcile the claim form with the medical chronology and payroll evidence](https://ailawframework.com/practice/personal-injury-and-compensation/reconcile-the-claim-form-with-the-medical-chronology-and-payroll-evidenc.md)

## 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).

## Authorities

- [State Insurance Regulatory Authority, Worker's injury claim form (effective 20 October 2026)](https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08684-Workers-injury-claim-form.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/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08684-Workers-injury-claim-form.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-workers-injury-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.*