Making a WorkCover Claim

What workcover compensation can I claim?

If you suffer injuries or illnesses that arise out of, or in the course of, your employment you may be entitled to several types of benefits that can help you and your family through difficult times. These can be broken down into five main categories.


 

Medical and rehabilitation benefits

These include the cost of medical treatment, pharmaceuticals and medications, rehabilitation treatment, replacement or provision of aids such as prescription glasses and artificial limbs, and travel to and from treatment. These benefits are paid provided the treatment is necessary to prevent the deterioration of your health or your ability to undertake the necessary activities of daily living, and provided the costs are reasonable.

You may also be entitled to home-help expenses such as gardening and home maintenance. You must retain accounts and receipts for all relevant expenses incurred.

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Income support if you are unable to work

The workers compensation insurer will compensate you for your loss of earnings if you are unable to return to work as a consequence of your injuries. 

The amount and type of weekly compensation payment you receive depends on the level of your capacity to work in your role at the time of your injury, or any other role. Such benefits may be payable until retirement age of 65, however, certain criteria must be met for you to continue receiving weekly payments after a period of 130 weeks. 

If you are partially fit for work and have resumed working in some form of suitable employment, then you may still be entitled to receive weekly compensation ‘top up’ payments. 

As long as you are able to do some work, even if it is not your previous duties, your employer has a legal obligation to provide you with suitable light duties. Furthermore, your WorkCover insurer and your employer must provide you with suitable rehabilitation services and assistance in returning to work. In return you have an obligation to co-operate with reasonable return to work programs.

If a dispute arises about your employment or return to work, do not resign your employment or accept a redundancy before seeking legal advice as this may significantly impact the compensation you can claim.

If your employer terminates your employment, we urge you to contact Slater & Gordon immediately as very short time limits apply to challenge the termination.

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Lump sum to cover permanent injuries

 You may be entitled to receive a lump sum payment if you have suffered a permanent impairment as a result of your injury or illness. In general, you cannot claim a lump sum payment unless and until your condition has stabilised. The insurer will arrange for you to be assessed by a suitably qualified medical practitioner to determine the level of permanent impairment. 

The likelihood of you obtaining an impairment benefit will depend on whether you meet the injury impairment threshold. The law classifies injury impairment as a percentage based on a set of uniform guidelines, which differs from a treating doctor’s assessment.

It is important to seek independent legal advice on whether you are entitled to claim a lump sum benefit. A Slater & Gordon lawyer can investigate your entitlement and ensure you comply with procedures set down in the legislation.

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Lump sum for the negligence of another party

You may be entitled to sue another party for a lump sum payment to compensate you for pain and suffering and loss of earnings. To do this it needs to be proven that the other party was at least partially at fault and that your injury meets the legal test of being a ‘serious injury'.

You should not make your own assessment as to whether your condition is 'serious'. The 'serious injury' test is complex and considers such factors as restrictions in your ability to carry out recreational, work and domestic activities. 

Our lawyers have many years of experience in this area and a solid track record of successful claims for negligence. We can make an accurate assessment as to who was at fault and help you in determining whether your injuries meet the legal requirements.

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Benefits to dependants of deceased workers

 Dependants of a deceased worker are also entitled to claim compensation. Compensation may include a lump sum benefit in excess of $500,000 as well as counselling and payment of funeral expenses up to a capped limit. 

Furthermore, dependents may be entitled to weekly payments. Dependants under the age of 16 may also be entitled to weekly payments. The age limit may increase to 25 years where the dependant remains in full-time education or apprenticeship.

We can help make sure that you know all of your rights

WorkCover is just one scheme that can assist someone when injured. If you’ve been injured at work you may be entitled to make alternative or additional claims for your injuries. 

Where your employment is terminated as a consequence of your injury, you may be entitled to make an unfairdismissal claim. It is important to seek legal advice immediately following termination of employment as strict time limits apply.

A disability benefit under your superannuation policy is another avenue we can explore. These benefits are in addition to the superannuation contributed by your employer to your fund. Superannuation disability benefits can be substantial, ranging from a few thousand to hundreds of thousands of dollars. In addition, some superannuation policies, or some private insurance policies, may provide access to salary continuance or similar types of benefits.

Don’t worry if this seems complex. That’s what we’re here for. Our lawyers at Slater & Gordon can fully assess your circumstances to see whether these claims apply. 

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What if I’m not happy with WorkCover’s decision?

A decision of the WorkCover insurer can be reviewed. The first step in the review process is to refer the dispute to the Accident Compensation Conciliation Service. This must normally be done within 60 days of the WorkCover decision. Slater & Gordon’s workers’ compensation lawyers can help you prepare your request for conciliation.

How do I make a WorkCover claim

For steps on making a WorkCover claim click here.

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