WORKCOVER

What Benefits are payable on an accepted WorkCover claim? 1. Weekly Payments: If you have an incapacity for work or a restriction/limit on your capacity to work, you will be entitled to receive a weekly payment. You are entitled to receive a weekly payment in lieu of your ordinary earnings. Weekly payments are paid at a reduced percentage of your ordinary earnings: •First 13 weeks of incapacity – 95% of your ordinary earnings •Subsequent 117 weeks of incapacity – 80% of your ordinary earnings. Your ordinary earnings are generally the average weekly amount that you earned prior to injury. This is calculated with reference to what you earned in the 52 weeks prior to your injury. There are maximum amounts that will be paid by way of a weekly payment and these maximum amounts increase each year. If your ordinary earnings include income generated from the performance of overtime work, this component of income is excluded after 52 weeks resulting in a reduction in your weekly payments. If you have a WorkCover claim which was accepted before 31 March 2024, you can obtain weekly payments for a period of more than 130 weeks if it is established that you have a permanent and total incapacity for all employment. If you are entitled to receive weekly payments beyond 130 weeks, they are then payable until the age of 67 years (unless injured when 67 or older and then you are entitled to a limit of 130 weeks of weekly payments). For WorkCover claims lodged and accepted after 31 March 2024, to receive weekly payments for a period of more than 130 weeks, you must undergo an impairment assessment pursuant to the AMA Guides and rate as having a 21% or more ‘Whole Person Impairment’ (‘WPI’). It also must also be determined that you have no current work capacity which is likely to continue indefinitely. There are other situations in which you may be entitled to weekly payments beyond 130 weeks. For example, if you have returned to work but are earning less than 80% of your pre-injury income and you have a whole person impairment of 21% or more, you may be entitled to a top-up payment from the insurer and this is payable potentially until the age of 67 years. Another situation is where you have received weekly payments for 130 weeks and then you return to work, but you subsequently have surgery causing a period of incapacity. In this situation, you may be entitled to an extra 3 months of weekly payments covering the surgery period and resultant recovery. Disputes can often arise in respect of the payment of weekly payments. Common disputes include the insurer incorrectly calculating ordinary earnings resulting in a reduced weekly payment and refusal to pay weekly payments in circumstances where they should be paid. If you have any concern about the payment of your weekly payments, please contact our office for advice. 2. You are entitled to be paid all reasonable medical and like expenses. The test as to whether a treatment/service will be paid is whether it is reasonable and appropriate and it provides a functional benefit to the performance of activities of daily life and/or your capacity to work. If you are seeking the insurer to fund a medical expense, you should obtain approval from the insurer prior to the expense being incurred. To do this, obtain a note from your treatment provider as to why the treatment/service is needed and then email that note to the insurer and request funding approval. The insurer has 10 days to respond. You should chase them up. If you receive a ‘no’ or you are otherwise unhappy with the insurer’s response/lack of response, then you should contact our office for advice. As a general rule, Mr Wolf Legal does not charge costs to assist you with having the insurer pay a medical treatment/service. The payment of medical and like expenses is not limited to medication and medical treatment. It includes ancillary matters such as retraining, gymnasium and swimming membership, home-help and gardening assistance. 3.Permanent Impairment Compensation is a once off payment payable in addition to weekly payments and medical and like expenses. It is a payment paid for permanent injuries only. To receive the payment, you must be assessed by an independent doctor appointed by the insurer. That doctor must then determine that you have rated at least the threshold level of impairment to receive compensation. There are three different thresholds depending on the nature of your injury. Physical injuries which are not musculoskeletal must rate 10%, psychiatric injuries must rate 30% and musculoskeletal injuries must rate 5% to receive compensation. Psychiatric injuries which are secondary/consequential to a physical injury are not entitled to be assessed for permanent impairment payment. The assessment of impairment is conducted in accordance with the American Medical Association Guides 4th Edition. As the payment is payable once only, the law requires that your injury is stable prior to making the claim. An injury is generally considered stable when it is unlikely to improve/deteriorate significantly in the foreseeable future. There is no set period of time in which you have to make an impairment claim so in other words, it is never too late. If you think you have sustained a permanent injury, we encourage you to contact the team at Mr Wolf Legal for some free advice.