--- title: "Application for mediation (NT WorkSafe): completion guide" url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-nt-wc-mediation" type: "precedent" site: "AI Law Framework" id: "a21-form-nt-wc-mediation" area_id: "A21" kind: "form" ai_level: "yellow" version: 1 task_ids: ["A21-T1-R1", "A21-T1-R4", "A21-T1-R5", "A21-A20260923-1", "A21-P20260916-2"] law_stated_as_at: "2026-10-22" --- # Application for mediation (NT WorkSafe): completion guide > Link to the NT WorkSafe application for mediation under the Return to Work Act 1986. The form page gives no form number.… Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-nt-wc-mediation Law stated as at: 2026-10-22 Site index for agents: https://ailawframework.com/llms.txt Link to the NT WorkSafe application for mediation under the Return to Work Act 1986. The form page gives no form number. For a rejection, reduction or cancellation, the mediation page states 90 days from receipt of the insurer's notice. The form file was not opened. ## 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: Northern Territory - AI level: Yellow. You and the tool draft together, with you directing. You check every statement you rely on. - Law stated as at: 2026-10-22 - Status: Maintained. Checked on 2026-10-22 against the official form at worksafe.nt.gov.au and the 2 authorities it cites, for Northern Territory. ## When to use it Use when an injured worker asks NT WorkSafe to refer a workers compensation dispute to mediation. The form page says the notice of decision that came with the insurer's decision may be used instead. Mediation is completed before a Work Health Court application. The tool does not write the dispute. ## Used for these tasks - [Calculate limitation and pre-action notice deadlines from the injury facts](https://ailawframework.com/practice/personal-injury-and-compensation/calculate-limitation-and-pre-action-notice-deadlines-from-the-injury-fac.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) - [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) - [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) - [Prepare the tribunal or commission document bundle from the lawyer-selected material](https://ailawframework.com/practice/personal-injury-and-compensation/prepare-the-tribunal-or-commission-document-bundle-from-the-lawyer-selec.md) ## How AI may be used AI may check the application against the current form and list missing records. The lawyer writes the grounds and any account of the injury, and checks every filing. **AI may:** - Check the application against the current official form and list missing records named on the page - Flag when a claim form, a review form, an expedited-decision form or a mediation form is being used for the wrong step - List the time limits and lodgement path stated on the page that was opened **AI must not:** - Must not draft the grounds, the injury narrative, or any words that would be lodged in the application - Must not invent a date of decision, a medical finding or a weekly rate - Must not sign, file or serve the application **The lawyer checks:** - The current mediation form, or the insurer's notice of decision and rights of appeal where the page allows that, is the document used - The 90-day period is applied only to a rejection, reduction or cancellation, as the page states - The 28-day period for the Work Health Court is counted from receipt of the certificate of mediation - The court's or tribunal's current index is checked before assuming a generative-AI practice direction applies. None was stated on the page opened for this guide. ## Authorities - [NT WorkSafe, Application for mediation](https://worksafe.nt.gov.au/forms-and-resources/forms/application-for-mediation) - [NT WorkSafe, Mediation](https://worksafe.nt.gov.au/workers-compensation/mediation) ## Official form [Official form](https://worksafe.nt.gov.au/forms-and-resources/forms/application-for-mediation) ## Where this comes from The official form is published by worksafe.nt.gov.au; this page is a completion guide. Last checked on 2026-10-22. ## 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-nt-wc-mediation 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.*