Workers compensation changes: Information for workers
In June 2012 the government introduced changes to the Workers Compensation Scheme in NSW. The reforms improve financial support for seriously injured workers, and provide more assistance for injured workers to return to work.
Focus on return to work
Evidence shows that getting back to work early is an important part of your recovery. In most cases, you do not need to be 100 per cent recovered to return to work. Assisting early, safe and durable return to work is a key intent of the reforms.
Under the changes:
- work capacity assessments determine your capacity to return to work and entitlement to weekly payments
- weekly payments are linked to return to work, with higher weekly payments during the first 13 weeks (when 80 per cent of injured workers return to work) and thereafter if you work for at least 15 hours a week
- SafeWork NSW inspectors have additional powers to enforce your employer's obligation to provide you with reasonable suitable employment for your return to work.
The workers compensation reforms have been implemented in stages from June 2012. If you were injured on or after 1 October 2012, you are subject to the new legislation and benefits.
If you made your claim prior to 1 October 2012, and were receiving weekly payments as at 1 October 2012, you will be transitioned to the new legislation during 2013.
Weekly payments for new 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.
- For the first 13 weeks of weekly payments, you will receive up to 95 per cent of your pre-injury earnings.
- In weeks 14–130, your weekly payments will be made up to 95 per cent of your pre-injury average weekly earnings if you return to work for at least 15 hours a week. Otherwise, you will receive up to 80 per cent.
- After 130 weeks, if you have capacity to work but are not working at least 15 hours a week and earning at least $168 per week then your weekly payments will cease. If you are working at least 15 hours and earning at least $168, or have no capacity to work, your weekly payments will continue at 80 per cent of your pre-injury earnings.
- For most workers, weekly payments are limited to a maximum of five years from the date of your claim (or when you reach retirement age, if that is sooner – at which stage you may receive commonwealth benefits).
- Your reasonably necessary medical and related expenses may be covered for up to 12 months after you cease to be entitled to weekly payments (or 12 months after you made your claim if you do not receive weekly payments).
If you made your claim prior to 1 October 2012, were receiving weekly payments as at 1 October 2012 and your circumstances remain the same, your existing weekly payment rate continues until you are transitioned to the new benefits. That will happen during 2013, following an assessment of your work capacity.
Work capacity assessments
Your employer's insurer now assesses your work capacity. This involves a review of your medical, functional and vocational status, and helps to inform decisions about your capacity to return to work in suitable employment and your entitlement to weekly payments. If you are assessed as having some capacity to work, you must make reasonable efforts to do so; otherwise, your weekly payments may be suspended or cease.
A work capacity assessment can occur at any point in the life of your claim. A decision must be made on your work capacity by 130 weeks and this will be reviewed at least every two years. This does not apply to seriously injured workers.
If you disagree with the insurer's decision on your work capacity, you should apply to your insurer for an internal review of the decision. If you are not satisfied with that decision you may then seek a merit review of the work capacity decision. If the issue is then not resolved to your satisfaction you may seek a review of the insurer's procedures by the Workers Compensation Independent Review Officer.
Complaints and disputes
We provide simple ways to dispute matters if you believe you have not been dealt with fairly. The process is as follows.
Contact the insurer first
Your case manager at the insurer is your first point of contact for all disputes and complaints. Case managers are familiar with your circumstances and trained to action and/or escalate the dispute.
Contact us second
If you have raised your dispute with the insurer and are still dissatisfied with the outcome or decision, contact us on 13 10 50. We will review the dispute and whether the insurer's management of the claim is in accordance with workers compensation policy and legislation.
If further action is required
If we are unable to assist with the dispute, we will explain your options. Depending on the nature of the dispute you may seek assistance from:
- Workers Compensation Commission
- NSW Ombudsman – ombo.nsw.gov.au
- Health Care Complaints Commission
- Administrative Decisions Tribunal.
In addition, the Workers Compensation Independent Review Office (WIRO) provides an independent complaints solution service if you are unhappy with a decision made by your insurer. WIRO also provides funding for legal advice. For more information, call WIRO on 13 94 76 or visit their website at wiro.nsw.gov.au
The information in this fact sheet is general only. To discuss the specific impact on your claim, please contact your claim manager. For more general information about the reforms, visit our workers compensation claims section or call 13 10 50.
This publication may contain work health and safety and workers compensation information. It may include some of your obligations under the various legislations that SIRA 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.
Catalogue No. WC01117 © Copyright SIRA NSW 0913