Workers compensation provides essential support for those injured on the job, but not all claims receive approval. For injured workers, receiving a Section 78 notice—the formal rejection letter from an insurer—can feel like the end of the road. It’s not. This notification is merely the beginning of a process that, with the right approach, can still lead to the benefits you deserve.
What Exactly Is a Section 78 Notice?
A Section 78 notice is a formal document issued by workers compensation insurers when they decide to deny your claim, dispute specific aspects of it, or reduce or terminate your benefits. Named after Section 78 of the Workplace Injury Management and Workers Compensation Act 1998, these notices must follow strict legal requirements designed to protect workers’ rights.
When that envelope arrives with “Important Notice about your claim under section 78 of the Workplace Injury Management and Workers Compensation Act 1998” printed across the top, it signals the beginning of a challenge—not the end of your claim.
Why Insurers Issue Section 78 Notices
Insurers issue these notices for various reasons, often leaving injured workers confused and stressed about their financial future. Common grounds for denial include:
- Employment relationship disputes: The insurer claims you don’t meet the legal definition of a “worker“
- Causation issues: They argue your injury didn’t arise from employment
- Contribution disputes: They contend your employment wasn’t a substantial contributing factor to your injury
- Medical disputes: The insurer believes your treatment isn’t “reasonably necessary“
- Pre-existing conditions: They attribute your symptoms to conditions that existed before your workplace injury
- Psychological injury claims: They assert your psychological injury resulted from “reasonable action” taken by your employer
What Must Be Included in a Valid Section 78 Notice
The law doesn’t allow insurers to deny claims without proper justification and transparency. A compliant Section 78 notice must include:
| Required Element | Description |
| Decision explanation | Clear statement of what the insurer has decided |
| Reasoning | Detailed explanation of why they’ve made this decision |
| Supporting documents | Copies of all evidence they relied upon (medical reports, etc.) |
| Review information | Instructions on how you can challenge their decision |
| Legal assistance details | Information about where you can get help |
If your notice lacks any of these elements, it may not comply with legal requirements—a point worth raising when you challenge the decision.
The Crucial First Steps After Receiving a Section 78 Notice
The moments after receiving a Section 78 notice are critical. Taking the right actions promptly can significantly impact your chances of successfully challenging the insurer’s decision.
Don’t Panic or Give Up
With the misunderstanding that an insurer’s decision is final, some abandon legitimate claims. Remember: insurers are businesses with financial incentives to minimise payouts. Their initial decision is just that—initial.
Read the Notice Carefully
Review every detail of the notice, paying special attention to:
- The specific benefits being denied
- The reasoning provided
- The evidence they cite
- The deadline for response (though there is technically no strict deadline in NSW, acting quickly improves your chances)
Gather Your Medical Records
Collect all relevant medical documentation, including:
- Treating doctor notes and reports
- Hospital records
- Test results
- Specialist opinions
Seek Legal Representation Immediately
This is perhaps the most important step. Workers compensation lawyers can challenge Section 78 notices and can dramatically improve your chances of success. Also, in NSW, the Independent Review Office (IRO) can fund approved lawyers, meaning you pay nothing for expert representation.
Three Pathways to Challenge a Section 78 Notice
When challenging an insurer’s decision, you have three main options:
Option 1: Request an Internal Review
You can ask the insurer to reconsider their decision by submitting additional information or addressing specific points in their reasoning. The insurer must respond within 14 days.
Reality check: While this is the simplest approach, internal reviews rarely result in reversed decisions. Insurers tend to stand by their initial assessments unless presented with compelling new evidence.
Option 2: Contact the Independent Review Office (IRO)
The IRO serves as an independent body that can:
- Liase with insurance companies on your behalf
- Connect you with approved lawyers at no cost to you
- Facilitate resolution without formal proceedings
This intermediate step often provides valuable support without immediately escalating to a tribunal.
Option 3: Apply to the Personal Injury Commission (PIC)
As of March 2021, the Personal Injury Commission (PIC) replaced the Workers Compensation Commission in NSW. Operating independently from insurers and employers, the Personal Injury Commission:
- Formally adjudicates workers compensation disputes
- Has the authority to overturn insurer decisions
- Provides a structured resolution process
A competent workers compensation lawyer can guide you through the PIC process, from filing the initial Application to Resolve a Dispute through to representation at teleconferences and in-person hearings.
The Power of Medical Evidence in Challenging Section 78 Notices
When insurers deny claims, they often rely heavily on their own Independent Medical Examinations (IMEs). These assessments may not fully capture your condition or may interpret findings in ways that favor the insurer’s position.
Challenging these medical opinions effectively requires:
- Independent Medical Examinations: Having your own IME conducted by a specialist familiar with workers compensation cases
- Treating Doctor Reports: Detailed statements from doctors who have treated you consistently
- Functional Capacity Evaluations: Assessments that document what you can and cannot do in real-world situations
These medical evaluations provide objective evidence that can directly counter the insurer’s claims about your condition or its relationship to your employment.
Common Mistakes to Avoid When Challenging a Section 78 Notice
Even legitimate claims can falter when workers make these common errors:
- Handling the challenge alone: Without legal expertise, you may miss crucial arguments or fail to gather the right evidence
- Accepting an insurer’s medical opinion without question: Always seek independent medical assessment
- Providing inconsistent information: Ensure your account of the injury remains consistent across all communications
- Failing to connect medical evidence to legal requirements: Effective challenges link medical findings to the specific legal criteria for workers compensation
What Happens If You Successfully Challenge a Section 78 Notice?
When your challenge succeeds, the rewards are substantial:
- Reinstatement of weekly payments: Weekly payments may be restored, often with back payments
- Coverage for medical expenses: The insurer must pay for reasonable and necessary treatment
- Access to rehabilitation services: Programs to help you return to work safely
- Potential lump sum compensation: For permanent impairment in eligible cases
Strategic Assistance for Challenges to Section 78 Notices
When clients come to us after receiving Section 78 notices, we immediately set in motion a comprehensive strategy:
- We thoroughly analyse the insurer’s decision and identify any procedural or substantive weaknesses
- We gather compelling medical evidence, including independent examinations
- We prepare detailed documentation that addresses each argument raised by the insurer
- We represent you through every stage of the dispute process
- We pursue all available benefits, including back payments if your claim is ultimately approved.
Also, our team will determine your eligibility for IRO-funded legal support without the complexity. If you want to learn more about how the IRO can help, read our article here.
Don’t Let a Section 78 Notice Be the Last Word on Your Claim
Remember: a Section 78 notice is just the insurer’s opening position, not the final decision on your entitlements. With expert legal help, many denied claims succeed.
Our experienced team can help navigate the complex process of challenging these decisions and pursue the compensation you deserve. Contact us for a free consultation about your Section 78 notice. With our no win no fee arrangement, you pay us nothing unless we win your case. Get in touch with one of our Workers Compensation Lawyers Cabramatta and Workers Compensation Lawyers Parramatta today for expert guidance.
