Most Frequently Asked Questions in Workers’ Comp Claims NSW

What is workers compensation?

Workers’ compensation, often shortened to workers’ comp, is a mandatory insurance program that provides financial and medical support to employees who suffer work-related injuries or illnesses. It acts as a safety net, ensuring injured workers receive the care they need to recover and maintain financial stability while unable to work.

Who benefits:

• Employees: If you’re injured due to your job, workers’ comp can cover medical expenses, lost wages, rehabilitation costs, and even permanent impairment benefits.
• Employers: By having this insurance, businesses comply with legal requirements and protect themselves from lawsuits related to workplace injuries.

Who’s covered in NSW workers compensation?

All employees in NSW are covered, regardless of employment type (full-time, part-time, casual).

What can you claim on workers compensation?

Depending on your specific situation, you may be eligible to claim a variety of benefits, including:

• Weekly payments: To replace a portion of your lost income while you’re unable to work, typically calculated at 95% of your pre-injury earnings for the first 13 weeks and 80% thereafter.
• Medical expenses: Covering the costs of doctors, specialists, hospitals, medication, and other necessary medical treatment related to your injury or illness.
• Rehabilitation expenses: Supporting your recovery through physiotherapy, occupational therapy, and other rehabilitation services.
• Home care expenses: If your injury requires assistance with daily living activities, workers compensation may cover expenses for in-home care and support.
• Modifications to your home or vehicle: To accommodate any permanent disabilities resulting from your injury and help you live independently.
• Permanent impairment lump sum: A one-time payment if your injury results in a lasting disability assessed by a doctor.
• Death benefits: Paid to your dependents if your work-related injury or illness leads to your death.
• Payment of damages compensation for past and future loss of income if you injury was caused by the negligence of your employer.

Remember: This is not an exhaustive list, and eligibility for specific benefits may vary depending on your individual circumstances.

Important Considerations:

• Reporting: Promptly report any work-related injury or illness to your employer to initiate the claim process.
• Seeking advice: Consulting a lawyer specializing in workers compensation can ensure you understand your rights and maximize your entitlements.
• Time limits: There are strict timeframes for lodging claims, so seeking help early is crucial.

How do I make a workers compensation claim?

If you have sustained an injury in the course of employment you must undertake the following steps:

Step 1. Notify the employer of the injury as soon as possible

Step 2. Record the injury in the employer’s register of injuries

Step 3. Obtain a Workers Compensation Certificate of Capacity from your general practitioner or hospital

Step 4. Notify the insurer of the injury (the insurer’s details are obtained from the employer who must provide the name when requested)

Step 5. Ensure that the Workers Compensation Certificate of Capacity and all Medical bills or expenses are given to the employer and a copy to the insurer

Once the scheme agent/insurer has been notified of an injury, the insurer will contact the worker and employer and will review the claim and commence provisional liability payments which must start within 7 days of receiving notification of the injury. If the insurer has a reasonable excuse not to commence provisional liability payments the insurer must notify the worker within 7 days of receiving the notification of injury.

A claim form is only required if:

• The insurer has a reasonable excuse not to commence provisional liability payments
• Weekly payments exceed the 12 week provisional liability period
• Provisional expenses exceed $7500 and there is not sufficient information to determine ongoing liability
• The injury has been notified but there is insufficient information to determine liability

What are the time limits for workers’ compensation claims?

A claim for Workers Compensation should be made as soon as possible following an injury or otherwise within 6 months of the injury, accident or death. If there is a failure to make a claim within 6 months and that failure is the result of ignorance, common mistake or absence from the State then a claim for workers compensation can still be made. If the claim is not made within 3 years of the date of injury, accident or death, then the claim cannot be made unless the injury resulted in the death or serious injury of the worker.

How long does a workers compensation claim take

Insurers typically have 7 days to decide whether to accept or reject your claim. This might be extended if they need more information, but they must notify you within 7 days if that’s the case.
In most cases, claims are accepted on a provisional basis for 12 weeks, meaning you receive payments while they investigate further.

Straightforward claims with no disputes might be resolved within a few months.
More complex cases involving serious injuries, medical disputes, or disagreements about liability can take much longer, potentially years.

Factors Affecting Workers Comp Claim Length:

Severity of injury: More serious injuries requiring extensive treatment or rehabilitation naturally take longer to resolve.
Medical complexity: Disputes about the cause or extent of your injury or disagreements on treatment plans can significantly delay the process.

When my workers comp claim is accepted what benefits do I receive?

If the insurer accepts liability for your claim then you will receive benefits under the Workers Compensation Act.

The major benefits include:

• Payment of weekly compensation: Replacing a portion of your pre-injury income while unable to work.
• Payment of lump-sum compensation for permanent impairment
• Medical and Hospital expenses: Covering treatment costs associated with your work-related injury or illness.

Other benefits payable are;

• Rehabilitation expenses
• Death benefits and funeral expenses
• Compensation for damage to property (e.g. clothing)

What is the maximum payout for workers compensation in NSW?

In NSW, the maximum payout for workers compensation isn’t a simple answer, as it depends on various factors. Let’s demystify it for you:

Weekly Payments:
Regular Claims: For most, the maximum per week that can be claimed is $2,423.60 and this increase with inflation every month, the payment. can go for 5 years. However, if your permanent impairment is greater than 20%, payments can be extended until retirement age.
Exceptions: Claimants with severe injuries and ongoing care needs might qualify for longer payments.

Lump Sum Payments:
Permanent Impairment: These range from $22,480 to a maximum of $713,660, based on the assessed impairment level.
Common Law Damages: If your employer’s negligence caused the injury, you may receive an lump sum amount of compensation for damages for loss of past and future economic loss, this can be significant compensation. Your WPI needs to be at least 15% to make such as claim know as a work injury damages claim.

What is lump sum compensation for permanent impairment?

An injured worker may obtain a lump sum amount of compensation if they have sustained a permanent impairment as a result of the injury which occurred in the course of employment. A permanent impairment is an injury that has stabilised and has resulted in an impairment that is unlikely to change within the next 12 months.

To determine if you are entitled to a lump sum amount of compensation for permanent impairment you are assessed by an independent medical examiner known as an AMS. The AMS makes an assessment of the whole person impairment using guidelines established by the WorkCover Authority of NSW.

You must obtain an assessment of greater than 10% whole person impairment to be eligible to obtain lump sum compensation for permanent impairment.

If you are eligible for lump-sum compensation for permanent impairment this is payable in addition to any benefits you are entitled to receive for weekly payments and medical expenses.

For more information, review our Workplace Compensation Claim Success guide here.

FAQ’s

Can stress leave be workers compensation?

While the term “stress leave” doesn’t exist in Australian legislation, understanding your options is crucial for your well-being. Stress itself isn’t covered by workers’ compensation. However, if stress manifests as a diagnosed psychological condition and can be proven to be directly caused by your work, you may be eligible for compensation and time off work. This process requires medical documentation and legal expertise.

Can casuals claim workers compensation?

Yes, casual employees in NSW are entitled to claim workers compensation if they are injured at work or suffer an illness due to their work. This applies regardless of their visa status or how long they have been employed.

Here are some key points to remember:

• Coverage: Casual employees are covered by the full range of benefits under the Workers Compensation Act 1987 (NSW).
• Benefits: These benefits include weekly compensation payments to replace lost income, medical expenses, and potential lump sum payments for permanent impairment.
• Reporting an injury: It’s crucial to notify your employer immediately if you are injured at work, regardless of how minor the injury seems. This helps ensure your claim is processed smoothly.
• Seeking advice: If you have questions about your eligibility or the claims process, consider seeking legal advice from a lawyer specializing in workers compensation.

Can I take annual leave while on workers compensation?

Yes, you can take annual leave while on workers compensation in NSW. This is allowed under the Workers Compensation Act 1987 (NSW), specifically Section 49.
Here are some key points to remember:

• You will continue to accrue annual leave at your normal rate while you are on workers compensation and remain employed.
• You must agree with your employer to take annual leave while on workers compensation. This means discussing the timing and duration of your leave with your employer and ensuring it aligns with your recovery plan and doctor’s advice.

There are some limitations:

• Your employer cannot force you to take annual leave while on workers compensation.
• You cannot take annual leave if it would delay your recovery or rehabilitation.
• Your employer may have reasonable business needs that could prevent you from taking your leave at your preferred time.

For more information, review our Annual Leave and Long Service Leave Whilst on Workers Compensation in NSW guide here.

Is workers compensation taxable?

Whether workers compensation is taxable in NSW depends on the type of payment you receive:

Weekly payments:
Yes, they are taxable. Weekly payments for lost wages or income are considered a substitute for your regular salary and are taxed the same way. Your employer should withhold tax before paying you.

Lump sum payments:
It depends. If the lump sum compensates only for lost wages or income, it is taxable. If the lump sum includes compensation for pain and suffering, permanent impairment, or future medical expenses, it is generally non-taxable. However, any interest earned on the lump sum or income generated from assets purchased with it might be taxable.

How long can you stay on workers compensation in Australia?

The length of time you can stay on workers compensation in Australia depends on several factors, including the state or territory you’re in and the nature of your injury. Here’s a general overview:
Generally Most states and territories have a 5-year limit on weekly payments. This applies if your injury is considered “stable and stationary” or you’ve reached “maximum medical improvement.” Some exemptions exist for specific groups like police officers, firefighters, and miners. Additionally, if your injury has a whole person impairment of 21% or more, there may be no time limit on certain benefits.

State-specific variations:

• New South Wales: Weekly payments are capped at 260 weeks (5 years) for impairments under 21%. For higher impairments or specific occupations, different rules apply.
• Queensland: Payments can last up to 5 years under most circumstances.
• Victoria: Like NSW, with a 260-week limit for most cases.

Important notes:
These are just general guidelines. Individual circumstances can be complex, so it’s crucial to consult with the relevant workers compensation authority in your state or territory for accurate information.
Even if your weekly payments stop, you may still be entitled to other benefits like medical treatment or lump sum payments depending on your situation.

Can you resign while on workers comp?

Yes, you can resign while on workers compensation in NSW. You still need to give your employer the correct notice period as outlined in your employment contract or relevant award. You can use your workers compensation period as your notice period. While resigning is your right, it may affect your entitlements, particularly weekly payments. This is because you have an obligation to be “ready, willing and able” to return to work duties. Starting a new job could be seen as contradicting this.

If your resignation is deemed unrelated to your work injury, your weekly compensation payments could be reduced or even terminated. Due to the potential complexities and impact on your claim, it’s highly recommended to seek professional advice from a lawyer before resigning while on workers compensation. They can assess your specific situation and guide you on the best course of action to protect your rights and entitlements.

Does surgery increase workers comp settlement?

Whether or not surgery increases your workers compensation settlement in NSW depends on several factors, and it’s important to understand this is a complex legal matter. Seeking professional legal advice is crucial for navigating your specific situation. Here is some general information to help you understand the potential impact of surgery on your case:
Surgery doesn’t automatically guarantee a higher settlement. It’s essential to consider:

If the surgery significantly improve your condition, it may not be approved by the insurer. Expensive or expensive surgeries might not be approved, especially if the cost outweighs the expected benefits. If the surgery has a high risk of complications or uncertain outcomes, the insurer might be hesitant to approve it.

Can a workers compensation claim be reopened?

Yes, a workers compensation claim can be reopened in NSW under certain circumstances.
Reasons for reopening:

• Recurrence of an existing injury: If your original work injury worsens or comes back, you can reopen your claim to receive further medical treatment and/or weekly payments.
• Need for further payments: This could include additional medical expenses, weekly payments for ongoing disability, or lump sum payments for permanent impairment.
• Data errors: If there was an error in the original assessment of your claim, you can have it reopened to get an accurate decision.
• Disputing a provisional liability decision: If you disagree with a provisional decision made by your insurer, you can request a formal review.

There is no strict time limit for reopening a claim, but the longer you wait, the more difficult it may be to provide evidence that your current condition is related to your work injury. However, it’s important to act quickly if you believe you have a valid reason for reopening your claim

Thank you for reading our article. We hope it helped your understand some of the key questions regarding Workers Compensation Claims in NSW. Should you have any further questions, please complete a free case assessment or find more information in our comprehensive Workers Compensation Claims Guide.