NSW workers compensation blog

Section 39 NSW: what to do before weekly payments hit 260 weeks

If your insurer says weekly payments will stop under section 39, treat it as an urgent dispute event. This guide shows the evidence and timeline actions that matter most before the cutoff date.

Start Free Claim Check Weekly payments stopped guide

Direct answer: can weekly payments continue after 260 weeks?

Sometimes, yes — but only where legal thresholds and evidence are prepared properly before the stop date. Treat section 39 as a coordinated dispute across week counting, capacity, impairment threshold, and wage assumptions.

Do not assume the insurer's week count is correct.
Do not rely on generic medical certificates.
Do not ignore PIAWE underpayment and arrears issues.
Do lock your dispute pathway before cessation date.

What to do in the next 48 hours

Request the insurer's week-count worksheet and written cessation reasoning in full.
Send your treating GP/specialist a targeted question list tied to capacity assumptions in the notice.
Pull payslips and wage records to check for PIAWE underpayment and arrears exposure.
Choose your primary dispute track (work capacity and/or PIC) before the cessation date.

If the insurer does not provide a complete worksheet immediately, build your own week ledger in parallel (paid week, amount, period covered, remittance reference). That single document often decides whether the stop date can be challenged in time.

Before sending anything critical, confirm the exact legal insurer and claims team details against the NSW insurer list and nominal insurer agents guide to reduce avoidable misdelivery delays.

Build a same-day section 39 evidence pack (simple, but powerful)

You do not need a perfect file on day one. You need a clean pack that shows you are organised, factual, and ready to challenge errors before the cutoff.

Document 1: insurer notice + any follow-up email or phone log (date/time/staff name/exact wording).
Document 2: your own week ledger (week ending date, amount paid, period covered, source record).
Document 3: treating evidence summary (diagnosis, functional limits, hours tolerated, restrictions).
Document 4: wage evidence bundle for PIAWE checks (ordinary earnings, overtime, allowances, second job where relevant).

Send one concise email to the insurer attaching this pack index and asking for a written response to each disputed point. This often narrows the dispute quickly and prevents later arguments about what was said.

Step 1: verify insurer week counting and notice wording

Start by confirming how the insurer counted your 260 weeks and whether they relied on other findings (such as capacity assumptions) to justify stopping payments. If a formal denial notice is involved, cross-check with the section 78 notice dispute guide so you can isolate errors early.

In many files, the count dispute is not about one obvious arithmetic mistake. It is about whether paused payments, partial weeks, graded return-to-work periods, or administrative holds were counted consistently. Require the insurer to show a week-by-week basis and reconcile that against your own payment records.

If the same letter also makes a work-capacity finding, split your response into two streams: (1) week-count/section 39 challenge, and (2) capacity-evidence challenge. Running both in parallel reduces the risk that one unresolved issue is used to delay the other before the cutoff date.

Step 2: collect targeted medical and work-capacity evidence

Section 39 disputes are often won or lost on detailed medical restrictions and impairment evidence. Generic certificates rarely move the insurer. Ask your treating team for diagnosis-linked restrictions, prognosis, and functional limits that address the insurer's assumptions directly.

What usually goes wrong before the 260-week cutoff

The insurer rarely frames a section 39 stoppage as just a week-count issue. In practice, payment cessation at 260 weeks is often bundled with arguments about your work capacity, earnings, treatment plateau, or whether you satisfy the serious-injury threshold. That means the strongest response is usually coordinated rather than one-dimensional.

The insurer says you are not a seriously injured worker

If the file is drifting toward a threshold fight, you need to understand how the greater-than-20% impairment test interacts with section 39. Start with the section 32A seriously injured worker guide and the lump sum WPI service page.

Capacity opinions are used to weaken your evidence

Even where section 39 is the headline issue, insurers often rely on IME reports or rehabilitation notes to argue you can sustain employment. Compare the reasoning with the work capacity decisions guide and the unfair IME report guide.

Underpayment issues get ignored because the stop date feels more urgent

If your PIAWE was wrong for months or years, the section 39 notice can hide a parallel arrears problem. Audit the numbers using the PIAWE calculation guide and the recalculation request guide.

Treatment evidence is too thin by the time payments stop

If treatment has already been delayed or denied, the insurer may say there is no current objective basis for ongoing incapacity. Rebuild that record early with the treatment denied guide and, where relevant, the surgery denied guide.

Step 3: pressure-test wage assumptions and arrears impact

Many claim files also include wage underpayment issues. If your pre-injury earnings were miscalculated, you may have additional recovery arguments. Pair your section 39 strategy with the PIAWE recalculation guide to identify any compounding loss.

Step 4: lock dispute pathway before payments stop

Waiting until after cessation can increase financial pressure and negotiation disadvantage. If work-capacity findings are part of the cutoff decision, use the work capacity dispute pathway and prepare escalation steps through the Personal Injury Commission process.

Practical tip: send a same-day email asking the insurer to confirm the legal entity, stop date, and full week-by-week worksheet in writing. That one email often exposes counting errors early and gives you a clean documentary trail if the matter escalates.

If any stop-date update is given by phone, treat it as unconfirmed until you receive written confirmation. Keep a short call log (date, time, staff name, exact wording) and reply by email the same day so the record cannot be reframed later.

When doctors disagree: use a one-page comparison table before the stop date

A common section 39 failure pattern is sending multiple medical reports without showing the insurer where they conflict. If one doctor says you can sustain part-time duties and another says your limits are tighter, build a one-page comparison table and send it with your evidence pack.

Column 1: report date and doctor name.
Column 2: specific restriction (hours, lifting, posture tolerance, travel tolerance).
Column 3: what objective finding supports it (exam finding, imaging, treatment response).
Column 4: why that point matters for week-count/capacity/threshold issues before 260 weeks.

Ask the insurer to identify in writing which opinion they rely on for each disputed issue. This often stops vague "capacity improved" assertions and makes escalation to PIC cleaner if needed.

7-day section 39 triage checklist

260-week calculation and stop date independently verified
Treating doctor and specialist evidence requested with detail
Capacity and wage assumptions checked for factual error
Dispute pathway selected before payment cessation date

If you want a fast second opinion before income is cut, request a free claim check and we can map immediate next steps from your notice and medical file.

Section 39 quick FAQ

What if the insurer only confirms the stop date by phone?

Ask for same-day written confirmation of the legal entity, stop date, and week-count basis. Keep a call log and send a follow-up email confirming your understanding.

What if the insurer or nominal insurer agent tells me to resend my section 39 response to another team?

Resend on the same day, but preserve a written chain: attach your earlier email, state the original send time, and ask both teams to confirm in writing which legal entity and claims team now holds the file. This protects you if deadline responsibility is later disputed.

What if two insurer teams give different week counts or different stop dates?

Treat conflicting numbers as an unresolved dispute, not as your error. Ask both teams for one reconciled week-by-week worksheet signed off by the legal insurer, attach both versions to your email, and reserve your rights on the stop date until one consistent calculation is provided in writing.

Should I wait for the full worksheet before preparing evidence?

No. Request the worksheet in writing, but build your own week ledger in parallel from payment records and remittances so your challenge is ready before the cutoff.

What if one letter combines section 39 and a work-capacity decision?

Run a dual-track response: challenge the 260-week count and challenge capacity findings at the same time. Do not let one track delay the other.

What if the insurer says “capacity improved” but gives no task or hours detail?

Ask for a task-level written explanation: proposed duties, tolerated hours, lifting/posture limits, and the exact medical material relied on. If those details are missing, say the assertion is too generic to justify section 39 outcomes and attach treating evidence that maps your restrictions to real job demands.

Should I copy insurer jargon in my section 39 response?

No. Keep your response in plain language and anchor each disputed point to records: counted week, amount paid, source document, and treating restriction. You can include insurer terms in brackets, but plain-language structure prevents avoidable misunderstanding and helps if the dispute escalates.

What if my GP and specialist reports conflict on capacity before the 260-week stop date?

Do not send both reports without context. Add a one-page comparison table showing each restriction, supporting finding, and why it matters to section 39 issues. Ask the insurer to state in writing which opinion they rely on and why. This reduces scope for selective quoting and helps preserve a clean escalation record.

What if the insurer schedules a second IME before giving the week-by-week section 39 worksheet?

Treat those as parallel tracks. Prepare for the IME, but still demand the full week-by-week worksheet and payment inputs in writing now. Make it clear that a second IME does not pause disclosure obligations or stop-date verification.

What if the insurer says “wait for the WPI result” before giving the week-by-week section 39 worksheet?

Keep the tracks separate. Ask for the week-by-week count and payment inputs now, while the WPI process continues in parallel. Confirm in writing that disclosure and stop-date verification are not deferred by pending impairment assessment, and reserve your rights on disputed weeks and arrears until full records are provided.

What do WPI, PIAWE, and IME mean in plain English?

WPI is whole person impairment (important for serious-injury threshold arguments), PIAWE is pre-injury average weekly earnings (critical for underpayment checks), and IME is an insurer-arranged independent medical exam that should be tested against your treating doctors' evidence.

If a serious-injury assessment is still pending, can I treat the insurer's week count as final?

No. Keep both tracks running: challenge the week count assumptions and continue serious-injury evidence preparation in parallel. Ask for written interim assumptions and reserve your position on the stop date and arrears until full calculations are disclosed.

The insurer keeps saying “worksheet” or “arrears” without details. What do I ask for?

Ask for a plain-English breakdown: each counted week, amount paid, period covered, and how any arrears figure was calculated. Request source records (remittance statements, payment history, wage inputs) and a written explanation of assumptions.

Can payment interruptions affect the 260-week count?

Yes. Pauses, partial weeks, and return-to-work intervals can shift counting. Reconcile each counted week against your actual payment history.

What if the insurer sends only a screenshot summary instead of a full worksheet?

Treat screenshot summaries as incomplete. Ask for the full week-by-week worksheet export, the inputs used for each week, and the source records behind totals. Confirm in writing that the summary is insufficient to verify the stop date.

If I am told to resend my section 39 response to a different insurer team, what should I send?

Send one short handover email: attach your original submission, state the first send date/time, include the notice reference, and ask both teams to confirm in writing the legal insurer entity, receiving team, and who owns the stop-date decision. End by reserving your rights on all deadlines until one reconciled response is provided.

What is the fastest useful evidence pack to send on day one?

Send a four-part pack: notice/communications log, your own week ledger, treating restrictions summary, and wage records for PIAWE checks. Ask for a written response to each disputed item.

Need an urgent review before weekly payments stop?

Section 39 disputes get more expensive and more stressful once income has already been cut off. If you have a notice, a stop date, or a threshold argument brewing, get the file checked now.

Start Free Claim Check Call (02) 9635 0889