Making psychological injury claims through icare: Insurance and Care NSW

Workplace experiences can have a serious impact on mental health. When this impact leads to a diagnosed psychological condition, workers in New South Wales may be able to access support through the icare workers compensation scheme.

This guide explains how to lodge a psychological injury claim through icare. It covers the types of conditions that may be accepted, how to prepare a strong application, and the kind of support available during and after the assessment period.

What is a psychological injury under icare?

In the context of workers' compensation, a psychological injury refers to a mental health condition that is caused by, or significantly worsened by, a person’s work. These conditions are also referred to as psychiatric injuries.

Common diagnoses include anxiety, depression, post-traumatic stress disorder (PTSD), and adjustment disorders. The condition must be clinically recognised, and your medical practitioner will need to confirm that work was a substantial contributing factor. 

Not every mental health issue experienced at work qualifies for compensation. Claims that are mostly caused by workload or reasonable management actions, such as performance reviews or disciplinary procedures, are usually excluded under the law and therefore declined.

For more details, check icare’s guide on psychological injury claims and their mental health claims hub.

What experiences at work can contribute to psychological injury?

Psychological injuries can develop in many ways, depending on the workplace and the individual. Some arise after a single traumatic incident. Others result from ongoing stress, poor culture, or exposure to bullying or harassment.

The common causes include:

• Violence or threats at work

• Workplace bullying or harassment

• Unsafe or high-pressure environments

• Lack of support or unrealistic expectations

The circumstances behind each claim will be assessed individually. The focus is not only on the symptoms but also on the work-related factors that have contributed to the condition. Note that claims based mainly on workload or pressure face a tighter assessment because work must be a substantial contributing factor.

Who can make a claim?

If you are employed in New South Wales, and your mental health condition is related to your work, you may be eligible to claim under icare’s scheme. This applies to most employees, including part-time and casual workers. Some contractors also qualify only when they meet the legal test for being a worker.

A formal diagnosis must be made by a medical doctor. Your claim must include evidence that employment played a major role in the development or worsening of your condition. Even if you had existing mental health challenges, you may still qualify if work made the situation worse.

If you're unsure about eligibility, use icare’s eligibility questionnaire can help you check if you can lodge a claim or explore other support options.

What documentation is needed?

To submit a psychological injury claim, you’ll need:

• A medical certificate or Certificate of Capacity that states your diagnosis and its connection to your employment

• A completed workers' compensation claim form with details about your injury, job, and employer

• Supporting evidence such as incident reports, HR correspondence, medical notes, or witness accounts

Include a timeline showing when symptoms started and what happened at work.

As for your medical certificate, it should clearly describe your condition using standard diagnostic terms. Phrases like “workplace stress” are not enough on their own. Your practitioner should explain how your work contributed to the diagnosis.

How to lodge a claim with icare?

The process generally involves the following steps:

1. Speak with your GP and obtain a medical certificate and Certificate of Capacity

2. Notify your employer about your condition and intention to lodge a claim

3. Submit the claim form to your employer or directly to the insurer if needed

4. The insurer will assess your claim and may request more information or arrange a further medical review

5. You’ll be notified of the outcome once a decision is made

Keep a personal copy of all documents and communications to make it easier to follow up or clarify details later.

Accessing treatment while your claim is being assessed

In many cases, you can start treatment before your claim is formally approved. This can include psychological therapy, GP visits, and medication related to your condition.

This is possible if the insurer accepts provisional liability and your GP recommends it. So, your treating practitioner will need to recommend this early support, and the insurer must agree that the injury likely relates to your work.

Early access to care can be critical for recovery. It also helps the insurer understand your needs during the claim assessment period.

What happens if your claim is approved?

If your claim is accepted, you may be eligible for:

• Ongoing treatment with a psychologist, psychiatrist, or other mental health professional

• Medication and allied health services

• Weekly payments if you are unable to work due to your condition

• Return to work planning and support tailored to your recovery

Your case manager and treating team will review your progress regularly. If you're not ready to return to your previous role, alternative duties or retraining may be arranged.

What if your claim is rejected?

If your claim is declined, the insurer must give written reasons. You can request a review of the decision or seek independent advice from a workers' compensation solicitor or union representative.

Disputes can be lodged with the Personal Injury Commission. There are time limits for requesting a review, so it’s important to act quickly.

Even if a claim is not accepted, ongoing care is still important. It’s best to continue attending appointments and seeking professional support at least until you feel more settled.

Also note that NSW is reviewing psychological-injury rules, and stricter thresholds may be introduced.

Final thoughts

Psychological injuries related to work can be deeply disruptive, but the icare system is designed to provide structured support when employment is a major contributing factor.

By understanding what’s involved, speaking with a qualified practitioner, and submitting the right documentation, you can begin to access the care and support needed for recovery.

Mental health recovery is a process, not a quick fix. Professional help, clear communication, and patience are key. When you’re ready, support is there to help you move forward in a way that feels safe and sustainable.