The NSW Workers Compensation Scheme can offer you a range of benefits if you suffer an injury in the course of your employment and the injury has been substantially caused by work. This is irrespective of whether or not you, or your employer, were at fault for the injury.
The types of Workers Compensation benefits you may be entitled to include:
- Weekly payments for wage loss.
- Medical, hospital and rehabilitation expenses.
- Lump sum for permanent impairment.
What benefits am I entitled to?
Weekly compensation benefits will be paid for the first 13 weeks of incapacity at the rate of 95% of the worker's "pre-injury average weekly earnings" ("PIAWE").
For incapacity from between 14 and 130 weeks, the rate payable is 80% of the worker's PIAWE. For any period after 130 weeks, entitlement to ongoing payments is dependent on the extent of incapacity and the extent to which a worker has returned to work.
Medical, Hospital and Rehabilitation Expenses
All reasonable medical expenses will be met by the insurer, provided the provision of services is approved in advance by the insurer (the requirement for pre-approval does not include regular consultations with the treating doctor).
Depending on the extent of the injury, the insurer is responsible to meet expenses for either two or five years after the injury, or after the time when weekly payments cease. If a worker is injured to the extent they are classed as a "worker with high needs", the cost of reasonably necessary treatment is ongoing until retirement age.
After the entitlement period ceases, in some limited circumstances an entitlement may start again for the costs of treatment, for example where the condition of the worker requires additional surgery which necessitates time away from work.
Lump Sum for Permanent Impairment
Where a worker has been left with a permanent degree of impairment and the injury has reached maximum medical improvement, there may be an entitlement to additional compensation by way of a lump sum for that permanent impairment.
Can I sue my employer?
In some circumstances, it is possible for a worker to sue their employer, if their employer’s negligence has caused the worker’s injury, and the worker’s injury is assessed above a certain threshold. This is known as a Work Injury Damages Claim, and allows the worker to seek compensation for past and future economic loss (wages and superannuation).
Do I need to see a lawyer?
Workers Compensation is a very technical and complex area of law, and it is recommended that you see a lawyer so that you are aware of your rights. This will help to ease some of the stress you may feel whilst on compensation. Your lawyer can provide you with a detailed preliminary advice, at no cost to you, regarding your entitlements under the scheme, and what to do if the insurer disputes any part of your claim. You should also seek legal advice if left with an ongoing permanent impairment and also if the insurer makes an offer to settle any part of your claim.
Immediate Reporting of Injuries
A workplace injury must be reported to the employer as soon as possible. Failure to do so could affect your entitlement to claim. Once the employer has been advised of an injury, the employer is obligated to notify the Workers Compensation insurer within 48 hours and the insurer should commence payment of compensation benefits within 7 days, (unless there is a reasonable excuse for not doing so). If the worker requires more than 12 weeks of incapacity from work, a claim form must be submitted. A claim must be made within six months of the date of injury or accident. In exceptional circumstances a worker can still pursue a claim in circumstances where a claim form has not been lodged within 6 months of the injury or accident.
Do I need to pay legal costs?
Where a Workers Compensation matter has merit, the Independent Review Office (IRO) provides funding to cover most workers’ legal costs and expenses. We confirm that Marsdens is approved as a provider under this scheme. Accordingly, you will not have to pay for the advice or representation you receive under the scheme.
For exempt workers and Work Injury Damages Claims, most of the legal costs and expenses are recoverable from the insurer upon a successful resolution.