Many workers are injured in NSW every year. The workers compensation insurer is obligated to assist with medical treatment expenses, weekly wage payments while you recover, and returning to work. But what happens if you are unable to find employment, or your injury is so serious that you cannot work? Your entitlement to weekly compensation and medical treatment expenses is determined with reference to your Whole Person Impairment (WPI).
Whole person impairment
Your level of WPI is assessed using guidelines set by the State Insurance Regulatory Authority (SIRA). The assessment must be conducted by a specialist who is accredited by SIRA. Usually an assessment is organised by your solicitor, although the insurance company can also organise such an assessment.
Your percentage of WPI determines whether you are eligible for lump sum compensation for your injury. However, it also determines how long you may be entitled to claim medical treatment and weekly payments of compensation.
Workers with less than 21% WPI are eligible to receive weekly payments of compensation for up to 130 weeks (approximately 2.5 years). An extension of this time is able to be sought from the insurer up to 260 weeks (approximately 5 years), provided certain criteria are met. However, weekly payments of compensation will always be cut off after 260 weeks for, due to section 39 of the Workers Compensation Act 1987.
These time limits are based on an aggregate number of weeks of payments received. That is, you must have actually received 130 or 260 weeks of payments. It is not simply based on how many weeks have passed since you lodged your claim. For example, you may have sustained an injury and received 100 weeks of payments, gone back to work for 10 weeks, then ceased work again. The 10 weeks you did not receive weekly payments do not count toward the number of weeks of weekly payments.
Workers with a WPI of at least 21% are exempt from section 39 and there is therefore no cut-off after 260 weeks. These workers are considered ‘workers with high needs’ under the legislation and are eligible to claim weekly payments until one year after their statutory retirement age, subject to meeting the criteria under section 38.
Medical treatment time limits are linked to WPI. Workers with a WPI of 10% or less, or who have not yet had their WPI assessed, are able to claim medical treatment for up to 2 years after either lodging a claim or the date they last received weekly payments, whichever is later. As a result, these workers will be able to claim medical treatment for their injury from between 2-7 years after lodging a claim (depending on how long they are receiving weekly payments).
Workers with a WPI of between 11-20% can receive medical treatment for up to five years from the later of the two milestones outlined above, effectively between 5-10 years, depending on when weekly payments cease.
Workers with a WPI of at least 21% are able to claim expenses for the rest of their life.
Have you lodged a worker’s compensation claim?
Have you lodged a claim and are wondering what your entitlements are? We recommend you seek legal advice. Contact Turner Freeman on 13 43 63.