WorkCover - Adviceline Injury Lawyers 

WorkCover Entitlements

What weekly payments am I entitled to?

Your employer has to pay the first 10 days of your time off work due to injury. Then, for the next 13 weeks if you can't work, you are entitled to 95% of your pre-injury average weekly earnings (subject to a maximum). Please contact our office for advice on how this is calculated. 

After 13 weeks and up to 130 weeks payments continue at 80% if you have no capacity for work.

If you are able to do some work, you are entitled to 80% of the difference between what you are earning and your pre-injury average weekly earnings.

Some workers can have their weekly payments continue past 130 weeks where they have no current capacity for work and that situation is likely to continue indefinitely.

If you are working at least 15 hours per week and are likely to continue indefinitely to be incapable of undertaking further or additional employment or work, you may be entitled to further compensation beyond 130 weeks. Please contact Adviceline Injury Lawyers to find out how to apply.

Can I claim pain and suffering compensation?

Some injured workers are entitled to pain and suffering compensation, but this will depend on how well you recover. The law only allows those left with permanent serious problems to receive pain and suffering compensation.

What is a permanent impairment benefit?

You may be entitled to a lump sum payment of compensation if you are left with a permanent impairment because of your injury. This is a benefit that is calculated in accordance with a formula depending on the level of impairment you are assessed as having.  An independent doctor would need to examine you in accordance with a guide published by the American Medical Association. There are minimum levels of impairment that you must have before you are entitled to a benefit, depending on when you were injured and what injury you suffer. This benefit does not impact on your entitlement to weekly payments, medical and like expenses, or a common law claim.

Can I dispute a decision about my entitlements?

If your claim is rejected or if a notice is received, for example, refusing to pay for a medical service and you want to dispute that notice, you must request conciliation. That is, have the matter referred to the Accident Compensation Conciliation Service (Conciliation). You can contact your union or Adviceline Injury Lawyers who can help complete and send the necessary form and if needed arrange to obtain a medical report or reports.

The aim of Conciliation is to try to resolve disputes without the need for court proceedings. All disputes must be referred to the Accident Compensation Conciliation Service as the first step before court proceedings can be taken.  In order to arrange for a disputed claim to be dealt with by the Accident Compensation Conciliation Service a Request for Conciliation form needs to be filled out and then sent to the Conciliation Service together with the notice you received. This must be done within 60 days of receiving the notice. It is possible to lodge a request outside that time frame and request an extension of time, however there is no guarantee that the extension of time will be granted by the Conciliation Service.

Conciliation

The Conciliation Service arranges a meeting between the you and the WorkCover insurer (your employer can also be present) with a view to seeing whether the dispute can be resolved. You can be assisted and advised at the conciliation meeting, but as they are informal meetings and no costs are payable, a lawyer can only act for you if the insurer and your employer agree. Two representation agencies, Union Assist and WorkCover Assist can help and advise you at the conciliation level.

At the conciliation the conciliator will typically ask you to explain why he or she believes they are entitled to compensation and then ask the claims agent to justify their opposition. It is then not uncommon for the conciliator to talk to the parties separately with a view to reaching an agreement. Frequently an agreement is reached. In very limited circumstances a conciliator can order that the worker be paid the compensation he or she is seeking even if the claims agent does not agree. However, in most situations where agreement cannot be reached, the conciliator either declares a genuine dispute or if the dispute is about a medical issue, refers that medical issue to a medical panel.

Medical Panel

If a conciliation officer refers a medical question to a medical panel, the Medical Panel is required to provide an answer to the medical question within 60 days. The Medical Panel usually consists of 2 or 3 doctors selected from a register of medical practitioners. The decision of the Medical Panel is binding. Other than in exceptional circumstances, there is no appeal from a Medical Panel decision to a court.

The medical panel will examine you then give written answers to the questions they have been asked and also an opinion setting out the reasons why they have answered the questions in the way they have.

Court Proceedings

If the conciliation service cannot resolve the dispute between the parties by discussion and the matter has not been referred to a Medical Panel to make a decision, a certificate of Genuine Dispute will be issued and then you can to take the matter to court. Most court proceedings are taken in the Magistrates Court. Some cases are taken to the County Court. Even if court proceedings have been commenced, either parties can seek leave of the court to have a matter referred to the Medical Panel.