Workers compensation changes: FAQs for employers
Workers compensation changes: FAQs for workers
In June 2012 the NSW government introduced changes to the Workers Compensation Scheme. Here are answers to some frequently asked questions about those changes.
What are the changes to workers compensation?
Recent changes to workers compensation involve transitioning injured workers' claims to a new benefits system, which includes changes to weekly payment calculations, entitlements to lump sum payments, and time limits for claiming medical and related expenses.
Who is exempt from the changes to workers compensation?
Those exempt from the recent changes to workers compensation are police officers, paramedics, firefighters, coal miners and workers who make dust diseases claims.
However, these workers need to submit the new certificate of capacity, which has replaced the old medical certificate, when making a claim (as do all other injured workers).
How are existing claims transitioned to the new benefits?
If you made your claim prior to 1 October 2012, it will be transitioned following a work capacity assessment and decision by your insurer in 2013. Until then, your entitlements will continue under the old benefits system.
If a decision on your work capacity may adversely affect your entitlements, you will be contacted by your case manager at least two weeks in advance to give you the opportunity to provide information about your injury or claim. You will get three months' notice before any change to your weekly payments as a result of a work capacity assessment.
What do work capacity assessments involve?
Work capacity assessments involve a review by the insurer of your medical, functional and vocational status, and help to inform decisions about your capacity to return to work in suitable employment and your entitlement to weekly payments.
They consider all available information, including your self report and injury management plan, information from the employer, reports from treating providers and independent medical reports.
Why is returning to work important?
Returning to work after an injury is important because evidence shows you recover from an injury better at work than at home.
Staying at work, or returning to work as soon as safely possible, is good for your health and wellbeing – whether it's on reduced hours in your normal job or on modified or alternative duties.
Long term absence from work can lead to isolation and poorer health.
What if I disagree with a work capacity decision?
If you disagree with the insurer's decision on your work capacity, you can seek a review from the insurer. If you disagree with their subsequent decision, you can then seek a review by WorkCover NSW. If still unresolved, you may seek a review by the WorkCover Independent Review Officer.
What changes are there to weekly payments?
Weekly payment calculations for new workers compensation claims are now based more closely on your real earnings prior to injury – incorporating overtime and shift allowance in the initial 52 weeks of weekly payments.
Under the changes to workers compensation, entitlement to weekly payments is linked to the injured worker's work capacity and work status, and how long they have been receiving weekly payments.
What is a certificate of capacity?
The WorkCover NSW – certificate of capacity (catalogue no. WC01300) has replaced the WorkCover medical certificate for all workers compensation claims from 1 October 2012. It helps the insurer to assess the worker's work capacity.
Parts A and B of the certificate are completed by the injured worker's treating doctor. Part C is a declaration by the worker as to whether they have engaged in any form of employment since the last certificate was provided.
The worker is responsible for providing a completed certificate of capacity to the employer or insurer to be eligible for weekly payments.
What changes are there to claiming medical expenses?
The changes to workers compensation limit payment of reasonably necessary medical and related expenses for most workers for up to 12 months after they stop receiving weekly payments (or from when they first claim if they are not entitled to weekly payments).
Seriously injured workers are exempt from this 12 month limit.
When do entitlement periods for weekly payments start?
Entitlement periods for weekly payments start from the date payments commence (not the date of claim or injury). Periods are based on aggregate weeks and do not need to be consecutive.
What impact do dependants have on weekly payments?
Dependants are no longer included in determining entitlements to weekly payments, under changes to workers compensation.
What benefits are there for seriously injured workers?
Seriously injured workers, who have a permanent impairment of more than 30 per cent, are exempt from the five-year limit on weekly payments and the 12 month limit for claiming medical and related expenses. They are also exempt from undergoing work capacity assessments, unless they request one as part of exploring their return to work options.
For general information about the changes to workers compensation, see WorkCover's fact sheet Workers compensation changes: Information for workers (catalogue no. WC03828), go to workcover.nsw.gov.au or call us on 13 10 50.
To discuss the impact of the changes on your claim, contact your case manager.
This publication may contain work health and safety and workers compensation information. It may include some of your obligations under the various legislations that WorkCover NSW administers. To ensure you comply with your legal obligations you must refer to the appropriate legislation.
Information on the latest laws can be checked by visiting the NSW legislation website legislation.nsw.gov.au
This publication does not represent a comprehensive statement of the law as it applies to particular problems or to individuals or as a substitute for legal advice. You should seek independent legal advice if you need assistance on the application of the law to your situation.
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