MORE INFORMATION

SIRA

SIRA's Customer Service Centre can help those who have raised a query or dispute with their insurer and are not satisfied with the outcome. Phone 13 10 50 or email contact@sira.nsw.gov.au.

WIRO

Workers Compensation Independent Review Officer can help workers with:

These notes have been substantially drawn from the SIRA guidelines We urge you to refer to them.

BENEFITS - GENERAL OVERVIEW

Provisional Payments

The insurer may make provisional payments before it determines liability (see Part B or Part C) to cover:

Weekly Payments

You may be entitled to weekly payments when a work related injury has resulted in a loss of earnings because you have been partially or totally incapacitated.

To determine the amount of compensation, you must first calculate your pre-injury average weekly earnings (PIAWE). It is often called average weekly earnings (AWE) and includes overtime and shift penalties.

During the first 52 weeks of weekly payments, the calculation of pre-injury average weekly earnings includes ordinary earnings plus overtime and shift allowance payments.

After 52 weeks of receiving weekly payments the calculation of pre-injury average weekly earnings will not include overtime and shift allowance payments.

Payments will vary depending on your capacity to work or do other duties. We do not cover these matters in this explanation. See the SIRA guidelines

FIRST 13 WEEKS:

In the first 13 weeks, the amount of your weekly payments are based on whichever is less:

1. 95 per cent of your pre-injury average weekly earnings, minus:
a.the value of any deductible amount if you have no capacity for work, or
b.your current weekly earnings if you have capacity to work.

2.The maximum weekly compensation amount minus:
a.the value of any deductible amount if you have no capacity for work, or
b.any current weekly earnings and the value of any deductible amount if you have capacity for work.

WEEKS 14 - 130

Where you have current work capacity and are working 15 hours or more per week, your weekly payments are based on the lesser of:

• 95 per cent of your pre-injury average weekly earnings minus your current weekly earnings, or the amount that you have been assessed as able to earn in suitable employment, and the value of any deductible amount, or
• the maximum weekly compensation amount minus any current weekly earnings and the value of any deductible amount.

Where you have current work capacity and are working less than 15 hours per week, your weekly payments are based on the lesser of:

• 80 per cent of your pre-injury average weekly earnings minus your current weekly earnings or the amount that you have been assessed as able to earn in suitable employment and the value of any deductible amount, or
• the maximum weekly compensation amount minus any current weekly earnings and the value of any deductible amount.

Where you have no capacity for work, your weekly payment is based on whichever is less:
80 per cent of your pre-injury average weekly earnings, minus the value of any deductible amount, or
the maximum weekly compensation amount minus the value of any deductible amount.

AFTER 52 WEEKS:

Any overtime or shift allowance will no longer be included in the calculation of your average weekly earnings.
Note: Payments after 130 weeks will stop unless:

• you have been assessed as having no current work capacity, and this is likely to continue indefinitely, or
• you are working at least 15 hours per week and earning at least $190 (indexed annually), and this is likely to continue indefinitely, AND
• you have completed an application for continued weekly payments after 130 weeks form and sent it to the insurer.

WEEKS 131 - 260

Payments after 130 weeks will stop unless:

• you have been assessed as having no current work capacity, and this is likely to continue indefinitely, or
• you are working at least 15 hours per week and earning at least $190 (indexed annually), and this is likely to continue indefinitely, AND
• you have completed an application for continued weekly payments after 130 weeks form and sent it to the insurer.

AFTER 260 WEEKS

Weekly payments will cease unless your level of permanent impairment is more than 20 per cent.

Maximum weekly compensation amount

The maximum weekly compensation amount is capped and indexed in April and October each year.

The maximum amount from 1 April 2018 to 30 September 2018 is $2,128.50.

Medical Expenses

Generally speaking, workers can claim expenses relating to medical treatments and services, including medicines, hospital and rehabilitation. Associated expenses may include hearing aids etc.

A worker (and escort if necessary) who needs to travel for an approved treatment or service is also entitled to be reimbursed for fares, travel costs and maintenance, necessarily and reasonably incurred. The worker must gain prior approval by the insurer for the incurred travel costs (unless the travel is for treatment exempt from prior approval).

Various conditions apply. See the SIRA guidelines

Domestic assistance

Workers can claim the cost of domestic assistance for tasks such as:

• household cleaning and laundry
• lawn or garden care
• transport not otherwise covered as a medical, hospital and rehabilitation expense.

Return to work assistance (new employment assistance)

Workers may be able to claim new employment assistance that will enable them to return to work with a new employer.

New employment assistance expenses may include:

• transport
• child care
• clothing
• education or training
• equipment, or
• any similar service or assistance.

Return to work assistance (education or training assistance)

Workers may be able to claim the cost of education or training that will assist them to return to work.

The cost of education or training may include:

• education or training course fees
• other related expenses (for example, text books, travel).

Property damage

Workers can also claim compensation for damage to some items of property.

If property is damaged because of a work-related accident, a worker can make a claim for the repair or replacement of:

• crutches
• artificial members, eyes, or teeth
• other artificial aids
• spectacles
• clothes

Lump sum compensation for permanent impairment

Workers can claim lump sum compensation, such as permanent impairment or permanent injuries.

Compensation must be based on an assessment of the impairment contained in a medical report from a permanent impairment assessor listed on the SIRA website, as trained in the assessment of the part or body system being assessed.

An insurer will make a settlement offer with information such as:

• the details of the compensation
• information about the injury
• the agreed percentage of permanent impairment or permanent injury
• details of how the offer was calculated
• appeal provisions

Payments in the event of death

If a worker dies as a result of an injury, the worker's dependants can be paid compensation for the death.

Each dependant may be able to seek funding for legal representation by contacting

In the event the insurer accepts liability for a work related death:

• dependants of a worker whose death as result of a work related injury occurred on or after 24 October 2007 are entitled to:a lump sum payment (currently $791,850)
• weekly payments ($141.80 per week) for each dependent child up to the age of 16 (or 21 if they are in full-time education)
• reasonable funeral expenses

Commutation of compensation

A commutation is where the worker and insurer agree to a lump sum, and the insurer is no longer liable to pay future weekly payments and/or medical, hospital and rehabilitation expenses for the injury.

RETIREMENT

If you're receiving weekly payments and reach retirement age, you may be entitled to receive weekly payments for up to 12 months after.

If you receive an injury on or after retiring age, you may be entitled to up to 12 months of weekly payments from the date of your first incapacity.

The retiring age is defined as the age a person is eligible to receive the age pension.

DISPUTE CATEGORIES

An insurer may dispute liability for many reasons, including, but not limited to: Reason to dispute liability
- Reference

The worker has not sustained an injury.
- Section 4 of the 1998 Act

The person is not a worker.
- Section 4 and 5, and Schedule 1, of the 1998 Act

Employment was not a substantial contributing factor to the injury.
- Section 9A of the 1987 Act

The psychological injury was wholly or predominantly caused by the employer's reasonable actions.
- Section 11A of the 1987 Act

Claimed medical, hospital and rehabilitation expenses are not reasonably necessary because of the injury.
- Section 60 of the 1987 Act

The claim for property damage covers items the Act does not.
- Section 74 and 75 of the 1987 Act

There is no total or partial incapacity for work.
- Section 33 of the 1987 Act

The degree of permanent impairment does not reach the required thresholds for a lump sum payment.
- Section 65A and 66 of the 1987 Act

The worker was injured on a journey with no real and substantial connection between their employment and the accident that caused the injury.
- Section 10 of the 1987 Act