Understanding your claim and what IRO does
After you report a workplace injury, your claim is managed by an insurer. The insurer makes decisions about your payments, treatment, and claim.
If you are not satisfied with how your insurer has handled your claim, IRO provides specific services to review and address those issues.
On this page
Who manages your claim
Your insurer depends on where you work.
Private Sector workers
Most private sector claims are managed through Icare. Your claim may be handled by insurers such as:
Public Sector workers
If you work for a NSW Government agency, your claim is managed through the Treasury Managed Fund (also known as Insurance for NSW), with claims handled by insurers such as:
Self-Insurers and Specialised Insurers
Some employers:
- hold a licence to manage their own workers compensation claims. They are known as ‘Self-Insurers’.
- take out workers compensation insurance with an insurer for a specific industry. These insurers are known as ‘Specialised Insurers’.
www.sira.nsw.gov.au
Visit the SIRA website to read a list of Self-Insurers and Specialised Insurers.
Insurer decisions and timeframes
Your insurer must tell you within seven (7) days if they will start payments.
They may:
- Start payments straight away, or
- Ask for more information
If more information is needed:
- They must explain what is missing
- A decision should be made within 21 day
IRO services for workers who are not satisfied with their claim
IRO provides services focused on insurer conduct and decision‑making.
Review complaints about insurers
You can contact IRO if you have a complaint about how your insurer has handled your claim.
This includes issues such as:
- Payments being reduced, stopped or delayed
- Treatment not being approved
- Your claim being declined
- Delays in decisions
- Poor communication or claim handling
IRO reviews these complaints and raises them directly with the insurer.
Contact the insurer and seek a response
IRO may contact the insurer to:
- Confirm details of your complaint
- Request a response
- Clarify how the law applies to your claim
Issues are usually addressed through direct engagement with the insurer.
Early resolution of claim issues
IRO focuses on resolving issues before they move to formal disputes.
This includes:
- Identifying problems in the claim
- Clarifying misunderstandings about entitlements
- Working with the insurer to reach an outcome
This service is limited to matters that can be resolved without formal legal proceedings.
Provide information about rights and obligations
IRO provides general information about:
- Your workers compensation entitlements
- What insurers must do under NSW law
- How the claims process works
IRO does not provide legal advice.
Access to funded legal assistance (ILARS)
If your issue cannot be resolved through a complaint, IRO manages access to legal funding through the Independent Legal Assistance and Review Service (ILARS).
Through ILARS:
- Eligible workers may receive funding for a lawyer
- Lawyers provide independent advice and help challenge decisions
- Legal fees and some expenses may be covered
IRO does not act as your lawyer and does not give legal advice.
When to use IRO services
IRO services apply when you have a problem with how your insurer has handled your claim, for example:
- You disagree with a decision
- Your payments or treatment have been affected
- There are delays or communication issues
Time limits for making a claim
You should make your claim as soon as possible to your insurer. In most cases you should make a claim within 6 months of your injury
In some situations:
- Claims may be accepted up to 3 years, or longer in serious cases
- Claims after 3 years may need approval from the regulator (SIRA)
Contacting IRO
If you have a complaint about your insurer, you can submit it through IRO’s online form or contact IRO directly.