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Under Section 78 of the NSW Workplace Injury Management and Workers’ Compensation Act 1998, an insurer cannot simply tell you over the phone that they are stopping payments or refusing treatment. They must issue a formal, written Section 78 Notice if they dispute liability for your claim or any part of it.
This notice isn’t just a simple “no.” Insurers are required to:
Before issuing this notice, the insurer must conduct an internal review of your file by someone not involved in the initial recommendation to deny the claim. They must carefully consider all evidence, including reports you or your doctors have submitted.
If the insurer decides to stop weekly payments based on this notice, they must give you a specific notice period:
An insurer might issue a Section 78 Notice if it believes there is credible evidence showing it is not liable. Common reasons include:
Important Note on Pre-existing Conditions: We often see insurers decline claims by stating that an injured worker has recovered from the initial injury, and any current problems are just due to a degenerative or pre-existing condition (essentially blaming ‘old age’). However, NSW law is clear: if your work injury aggravated, accelerated, exacerbated, or deteriorated a pre-existing condition, the insurer is generally still liable for weekly payments and medical expenses related to that aggravation. PK Simpson has a strong track record of successfully challenging insurer decisions made on this basis in the Workers’ Compensation Commission.
No. Sometimes, an insurer might reduce or stop payments because they believe you have some capacity to return to work (either your old job or suitable alternative duties). This is called a Work Capacity Decision, not a liability dispute covered by a Section 78 Notice. These decisions have a different review process, often involving the Personal Injury Commission or WIRO (Workers Compensation Independent Review Office), and specific rules apply regarding legal representation and costs.
Receiving this notice doesn’t mean your claim is over. You have the right to challenge the insurer’s decision. Here are the main steps:
Fighting an insurer can seem daunting, especially financially. Thankfully, in NSW, injured workers challenging Section 78 Notices generally don’t pay legal costs directly.
If the WCC Arbitrator overturns the insurer’s decision:
A Section 78 Notice is a serious matter, but it’s often not the final word. Since 1977, the PK Simpson Injury Compensation Lawyers firm has served the people of New South Wales and across Australia and helped them gain deserved compensation. Our lawyers have the expertise and dedication to challenge unfair insurer decisions and fight for the compensation you are entitled to receive. If an insurer has declined liability for your workers’ compensation claim using a Section 78 Notice, contact us immediately.
Contact us today and let our expert compensation lawyers review your situation and guide you through the next steps. We’re here to help you get the support and compensation you deserve.
