How do I claim workers compensation?- Top
From 1 January 2002, if you suffer a work-related injury you will not, in most cases, need to submit a claim form to receive workers compensation. Generally, weekly payments will commence within seven days of your employer's insurer being notified of your injury. Notification of an injury can be written or verbal.
These payments, called 'provisional liability payments' can be made for up to 12 weeks and are designed to reduce the impact of injury and illness. They do not mean an admission of liability by the insurer or employer. In the same way, a claim for medical expenses compensation of up to $5000 may be accepted provisionally.
However, in some cases, you will need to make a claim for workers compensation:
- if your employer's insurer asks you to make one
- you require benefits that exceed your entitlements (ie. weekly payments for more than 12 weeks or medical expenses of more than $5000) under the new streamlined injury notification/claims processing system
- the insurer has stopped making provisional payments and you think that you are still entitled to more benefits.
When an injury has occurred, you must:
- report the injury or work-related illness to your employer (or supervisor) as soon as possible
- enter details in your employer's Register of Injuries (if there is one) - or ask your employer or supervisor to do so
- obtain a WorkCover medical certificate from your treating doctor and give the certificate to your employer.
If you are going to be off work for more than seven days, ask your doctor and employer about suitable duties and participate in the injury management plan to help you get back to work. You must make all reasonable efforts to return to work as soon as possible.
You should also:
- ask your employer to contact their insurer
- keep in contact with your employer and your employer's insurer while you are recovering from your injury
- keep a copy of any documents relating to your injury.
If you need more help or advice, or if there is a problem or a dispute:
- ask the Claims Assistance Service for help and advice on 13 10 50
- contact the Workers Compensation Commission if there is a dispute on 1300 368 040 or visit their website at http://www.wcc.nsw.gov.au/
How should an employer deal with a workers compensation claim?- Top
If a worker is injured, as an employer you must:
- notify your insurer within 48 hours of becoming aware of a workplace injury
- cooperate and participate in the establishment of an injury management plan for your injured worker. Your insurer should contact you and the worker within three days of receiving notice of injury, to get this plan underway
- provide suitable employment for an injured worker wherever possible. The employment must be suited to the worker, having regard to the worker's injury and the employment the worker was in at the time of injury
- notify your insurer if unable to provide suitable employment.
Note: Failure to provide suitable duties at the request of a worker may have an impact on your workers compensation premiums.
If a worker wants to make a workers compensation claim, as an employer you must:
- notify the insurer that a worker wants to claim workers compensation, even if you don't agree that the injury is work related. The insurer will ask you and your worker for facts about what happened
- send the workers compensation claim form (if required by the insurer), medical certificate or further documentation related to the claim to your insurer within seven days of receiving them
- provide the name and address of your workers compensation insurer to an injured worker if requested
- pay the worker any money received for workers compensation benefits as soon as practicable.
Is there a time limit for making a workers compensation claim?- Top
A claim for workers compensation should be made within six months of the date of injury, accident or, where relevant, date of death.
However, if the failure to make a claim within six months is the result of ignorance, mistake, absence from the State or other reasonable cause, a claim for workers compensation can still be made.
A claim lodged up to three years from the date of injury, accident or, where relevant, date of death can be determined by insurers in the usual manner.
In some cases, if a claim is not made within three years but the claim relates to an injury resulting in death or serious permanent disablement of the worker, the claim may still be allowed to be made. Further advice in this regard should be obtained from the insurer.
Compensation may not be recovered unless notice of the injury has been given to the employer as soon as possible after the injury happened and before the worker has voluntarily left the employment in which the worker was in at the time of the injury.
What happens after my injury has been notified?- Top
If you have a work-related injury and need to be paid compensation for either the time you are off work or medical expenses, your employer should notify the insurer.
Your employer must notify the insurer within two days if you will be away from your normal duties for seven or more calendar days continuously (this is called a 'significant injury') after becoming aware of your injury.
Your employer's insurer is obliged to begin weekly compensation payments within seven days of being notified of your injury, except if there is a reasonable excuse not to do so, such as when there is insufficient medical information or the injury is not work related. If the insurance company has made a decision to not start your payments they must tell you of that decision and the reasons for it, in writing.
These payments, called 'provisional liability payments' can be made for up to 12 weeks and are designed to reduce the impact of injury and illness. They do not mean an admission of liability by the insurer or employer. In the same way, a claim for medical expenses compensation up to $5000 may be accepted provisionally.
If you are going to be off work for more than seven days, ask your doctor and employer about suitable duties and participate in the plan to help you get back to work. You must make all reasonable efforts to return to work as soon as possible.
Weekly compensation is payable either:
- at the usual times that your employer pays wages, or
- at fortnightly or shorter intervals.
Your employer and your employer's insurer will decide who should pay you. Often, it is easier for your employer to continue paying you and to be reimbursed by their insurer. In some instances, the insurer may pay you directly.
Make a note of the notification/claim number and quote it on all documents sent to your employer and your employer's insurer.
When can you claim workers compensation?- Top
Workers compensation benefits are payable when a worker suffers an injury or contracts a disease which arises out of, or in the course of, their employment - and where the employment is a substantial contributing factor.
Workers compensation benefits are also payable for injuries received on a normal journey to or from work (without significant interruption or diversion), or during an authorised recess, providing the worker did not expose themselves to any abnormal risk of injury.
The workers compensation system provides for:
- loss of income during total or partial incapacity for work
- medical, hospital and rehabilitation expenses
- property damage
as well as other assistance to injured workers and their dependents.
Who is eligible to claim workers compensation?- Top
A person who is a 'worker' or 'deemed worker' under the Workplace Injury Management and Workers Compensation Act 1998 is eligible to claim workers compensation.
The word 'worker' is used to describe an employee under the Act. Worker means any person who has entered into, or works under, a contract of service or apprenticeship with an employer - or a deemed worker, as described by the Act.
Generally, a worker is someone who receives wages or commission regardless of the number of hours worked each week and includes workers who work away from the employer's premises.
Some examples of deemed workers are:
- outworkers
- contractors
- a person who contracts to do certain kinds of rural work
- taxi drivers
- sales representatives
- jockeys and certain harness racing drivers
- casual or part time workers.