What happened: An appeal panel ruled a workers' comp insurer failed to verify the accuracy of personal information before using it to cut an injured worker's impairment rating
Who's involved: Insurance and Care NSW (icare) and QBE Insurance Australia (claims agent)
What's at stake: The worker's whole person impairment rating was cut from 15% to 4%, below the threshold for permanent impairment compensation, before ultimately settling at 20%
Why it matters: Insurers in NSW can no longer rely on having 'no reason to doubt' information as grounds for skipping accuracy checks before use
Where it stands: Appeal allowed in part, remitted to the Tribunal for redetermination
A stand-up comedian's paid gigs were reclassified as evidence she could socialise - and used to deny her workers' compensation claim.
That is the short version of a NSW privacy dispute that has now rewritten the rules on how insurers handle personal information in claims management. In GJO v Insurance and Care NSW [2026] NSWCATAP 358, handed down on November 11, 2026, the NSW Civil and Administrative Tribunal's Appeal Panel found that Insurance and Care NSW (icare) breached its obligations under the state's privacy legislation when it used unverified - and partly inaccurate - information to reject an injured worker's permanent impairment claim.
The worker, identified only as GJO under a suppression order, sustained a psychological injury following workplace events in December 2020. Her claim was managed by QBE Insurance Australia on behalf of icare, the NSW Government workers' compensation authority.
In October 2022, a psychiatrist engaged as an independent medical examiner assessed GJO's whole person impairment - the measure used to determine eligibility for permanent impairment compensation in NSW - at 15%. That was comfortably above the 10% threshold required under the Workers Compensation Act 1987 (NSW).
Two months later, the insurer's lawyers wrote to the same psychiatrist asking him to reconsider three of his scores. The letter pointed to "evidence demonstrating the claimant's ability to attend various social functions and perform at same" and listed six stand-up comedy performances across 2021 and 2022.
The psychiatrist produced a supplementary report. Without explaining his change of view, he dropped GJO's score for social and recreational activities from 3 to 1, concentration, persistence and pace from 3 to 1, and employability from 4 to 2. Her whole person impairment fell from 15% to 4% - well below the compensation threshold.
QBE denied her permanent impairment claim two days later.
The problem, as GJO saw it, was that the comedy performances were paid professional work - not social outings. Under the Psychiatric Impairment Rating Scale used to assess these claims, social and recreational activities are scored separately from employability. Describing a paid gig under the heading of social functioning left the impression she was out socialising when she was, in fact, working. The insurer's lawyers had not consulted GJO before sending the letter, and she was given no chance to comment before the supplementary report was used to reject her claim.
GJO raised the inaccuracies with QBE in early 2023 and filed a detailed rebuttal. The psychiatrist himself eventually said "fresh eyes" were needed. None of that stopped the insurer from continuing to rely on the supplementary report - including filing it with the Personal Injury Commission in December 2023.
GJO's workers' compensation claim ultimately settled at 20% whole person impairment. But her privacy complaint lived on.
At first instance, the Tribunal found no breach. It reasoned that the insurer had "no reason to doubt the accuracy or veracity of the information" before using it, and therefore no further steps were required.
The Appeal Panel disagreed. Section 16 of the Privacy and Personal Information Protection Act 1998 (NSW) uses mandatory language: a public sector agency "must not use" personal information without taking reasonable steps to "ensure" it is accurate. Asking whether the agency had reason to doubt the information, the panel found, was "to start in the wrong place and to ask the wrong question." The obligation is to actively verify - not to wait for red flags.
The Appeal Panel also overturned the Tribunal's finding on the insurer's obligation to fix inaccurate records. The Tribunal had reasoned that because the workers' compensation claim was settled, the supplementary report "no longer serves any purpose" and there was "no need for alterations."
That too was wrong, the panel found. The correction provisions impose an unqualified obligation to ensure accuracy when an individual requests amendments. The word "appropriate" in the statute refers to the nature and scope of the corrections - not whether the agency gets to decide if correcting is worthwhile. An insurer cannot decline to fix inaccurate records simply because it has finished using them.
The matter has been sent back to the Tribunal to reconsider both the accuracy-before-use question and the correction obligation.
For claims teams and scheme agents handling workers' compensation in NSW, the ruling draws a hard line: checking the accuracy of personal and health information before using it is not optional, and the obligation to correct inaccurate records does not expire when a file is closed.
