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WorkCover Internet > Injuries and claims > Making a claim > Permanent impairment claims

Permanent impairment claims 

If a worker has a permanent impairment as a result of a workplace injury or illness, the worker may be entitled to receive lump sum permanent impairment compensation.

Lump sum compensation for permanent impairment is made under the Workers Compensation Act 1987 (1987 Act). This is in addition to other benefits available under workers compensation (for example, weekly payments and medical expenses and rehabilitation costs). 

 

Eligibility

Payments for lump sum permanent impairment compensation made on or after 19 June  2012, including those for injuries that occurred on and from 1 January 2002, are based on an assessment of the injured worker’s whole person permanent impairment.

A minimum level of permanent impairment must be present before payment can be made.  The minimum level is greater than 10 per cent permanent impairment, except for primary psychiatric and psychological impairments which require a minimum level of 15 per cent permanent impairment.

Note: An injured worker who made a claim of any sort before 19 June 2012 in respect of the same injury may be entitled to lump sum compensation for injuries assessed below the minimum level.

 

Assessment of permanent impairment

The impairment must be assessed using the WorkCover guides for the evaluation of permanent impairment by a suitably qualified medical specialist who is trained in the use of the guides and is listed on the WorkCover website.
 
The injury must have reached maximum medical improvement. This means the condition has been medically stable for the previous three months and further recovery or deterioration of more than three per cent is not expected in the next 12 months.  

 

Making a claim for permanent impairment

A Permanent impairment claim form is required unless the worker’s claim for weekly and other benefits has already included a claim for lump sum compensation for permanent impairment.  The form provides details of the information that must be supplied when making a claim for permanent impairment. Only one claim for permanent impairment compensation can be made in respect of the injury. 

Note: An injured worker who made a claim of any sort before 19 June 2012 in respect of the same injury may be entitled to make more than one lump sum compensation claim.

As required by the WorkCover Guidelines for Claiming Compensation Benefits the employer must:

  • send the claim to the insurer within seven days of receiving it
  • respond to requests from the insurer for more information within seven days
  • forward any documentation concerning the claim to the insurer within seven days.

If the insurer is satisfied with the supporting documentation, it may accept the worker’s permanent impairment assessment and settle the claim for permanent impairment, without needing to obtain additional assessments.

 

Complying agreement

A complying agreement is a written agreement between the injured worker and the insurer regarding the lump sum payment for permanent impairment. Prior to making the payment for permanent impairment to the injured worker, the insurer must be satisfied that the injured worker has obtained independent legal advice or has waived the right to independent legal advice. The insurer is required to record evidence that this advice has been obtained, or that it has not been obtained, and the details of the agreement. 

 

Benefits payable for permanent impairment

The maximum lump sum payment for permanent impairment injuries incurred: 

  • between 1 January 2002 and 31 December 2006 is $200,000, with an additional five per cent for permanent impairment of the spine  for injuries on or after 1 January 2006
  • on or after 1 January 2007 the maximum amount is $220,000 (plus an additional five per cent for permanent impairment of the spine).

View detailed information on benefits (payable for permanent impairment and pain and suffering compensation in the Workers compensation benefits guide

 

WorkCover Independent Review Office

The injured worker is responsible for their own legal costs with regard to their claim for lump sum compensation but the WorkCover Independent Review Office (WIRO) has established the Independent Legal Assistance and Review Service. This service provides access to free independent legal advice to injured workers through the provision of a grant, where there is disagreement with insurers regarding their claim for lump sum compensation for permanent impairment.

You can call the WIRO on 13 94 76 or contact them by email to complaints@wiro.nsw.gov.au.

 

Fact sheet

The WorkCover Independent Review Office factsheet contains general information about workers compensation entitlements and procedures. This factsheet is not a detailed explanation of the law as it applies to claims made by individual workers. For information about your claim, you should contact WorkCover on 13 10 50 or the WorkCover Independent Review Office (WIRO) on 13 94 76.