What benefits are available to injured workers?- Top
Provisional payments
From 1 January 2002, workers compensation has changed in NSW.
Weekly benefits will be payable to workers, in most cases, within seven days of the workers compensation insurer receiving initial notification of injury. These can be paid for a maximum period of 12 weeks if required.
There is also provision for the 'provisional' acceptance of liability and payment of medical expenses for an amount of up to $5000.
These provisional payments are designed to reduce the impact of injury and illness, but do not mean an admission of liability by either the insurer or the employer.
In many cases, an injured worker will not need to lodge a claim form if they are only going to be away from their normal duties for a short time. However, a claim form can still be lodged if an injured worker so desires. Sometimes, the insurer will require that a claim form be lodged.
If a claim is lodged
The insurer will decide within 21 days whether to accept liability for the workers compensation claim, or to dispute the claim.
If a claim is accepted, the insurer will:
- pay reasonable medical and rehabilitation costs
- determine the amount of weekly benefit
- assess other benefits to which you may be entitled.
The insurer is entitled to send a worker for medical examinations when making decisions about a claim. You must attend these medical appointments.
Financial assistance available
If your claim is accepted by the insurer, you may be eligible for the following assistance:
Weekly payments
These are made while you are unable to perform your normal duties because of your injury or illness.
Total Incapacity
If you are unable to do any work, the insurer will pay the weekly award rate for the first 26 weeks of total incapacity. The rate does not include any overtime or allowances that may have been part of your regular pay.
After 26 weeks, the statutory rate will be paid, until you are fit to resume normal work or some work.
The statutory rate is usually lower than the award rate, though it can be higher where there are a large number of dependants. In this case, the statutory rate is reduced to the equivalent weekly award rate of pay.
Partial Incapacity
Once the doctor declares you medically fit for some work, your rate of weekly payments will be determined by whether your employer can provide suitable duties for you. This might involve working fewer hours, or doing a completely different job for a short or indefinite period.
Sometimes, this may mean you will be earning less than you were before your injury. In these cases, the insurer will pay you 'make-up pay'.
If you are deemed permanently partially incapacitated, you may be entitled to section 40 benefits until age 66. In this case, you may find yourself working usual pre-injury award hours, but in a lighter capacity.
If your employer does not provide suitable work, the insurer may pay a special weekly benefit up to a maximum of 52 weeks. To receive this benefit, you need to be either actively looking for work or undertaking rehabilitation.
If your employer offers suitable work and you refuse to accept it, the insurer may reduce or stop your weekly payments.
Other financial assistance
Other financial assistance to which you may be entitled includes:
- reasonable medical and hospital expenses arising from your injury or illness
- travel expenses in attending appointments for medical and other treatment.
- rehabilitation services to help you return to work.
- payment for certain personal items, such as clothing or spectacles, if they were damaged in a work-related accident
- a lump sum payment for permanent impairment. In some cases, you can also receive a lump sum payment for the pain, distress and anxiety suffered.
What must a worker do if injured at work?- Top
If you suffer an injury at work, you must:
- tell the employer, as soon as possible, that you are injured and how long you will be off work. If you have an illness that you believe is work related, you should report it as soon as you become aware of it. Notification of an injury can be written or verbal
- inform the employer of your injury If you plan to leave your job voluntarily eg. if you resign, inform the employer of your injury before you leave
- record the details of the injury in the Register of Injuries if there is one in your workplace
- see your doctor and have them complete a WorkCover medical certificate. Give this to your employer and attach any bills or receipts for treatment
- ask your employer to notify their workers compensation insurer of your injury. You will be asked some details and given a notification number from the insurer
- in some cases, you may have to complete a workers compensation claim form. Return this to your employer, along with any other documents the insurer may request.
- have the right to nominate a treating doctor who will actively manage your injury in consultation with your employer and the insurer, if you suffered a 'significant injury'
- ensure that your employer has notified their insurer within two days and forwarded the associated documents to the insurer within seven days
- discuss a return-to-work plan with your employer. Large employers have a staff return-to-work coordinator whose job is to assist injured workers return to work
- speak with the insurer who will contact you within three days of receiving your employer's advice to discuss your treatment needs and to develop a cooperative injury management plan with your doctor, your employer or rehabilitation service provider.
- comply with the agreed injury management plan and take all reasonable efforts to return to work as soon as possible. If you fail to comply with any of the above obligations, the insurer can suspend weekly benefit payments.
The return-to-work plan will include details of the treatment required for the injury, when you can return to work, identify suitable duties you can perform in lieu of your normal duties and whether an employer can make these duties available.
The insurer is then able to pay for medical and other treatment expenses included in this plan.