Important changes to Workers’ compensation entitlements
For many injured workers, July 1 will signal the end of the road for worker’s compensation income support. Medical expenses will cease shortly thereafter. This blog provides a general and simplified outline to assist workers understand their entitlements and to prepare for transition from the workers compensation system.
The Return to Work Act 2014 (RTW Act) governs state worker’s compensation claims. It commenced on 1 July 2015 and captures all injuries or conditions that occurred on or after that date. The Act also operates retrospectively which means that it also captures an injury or condition sustained before 1 July 2015. An injury or condition sustained before the commencement of the RTW Act is referred to as an existing injury.
Under the RTW Act an injured worker can claim:
- Weekly payments of income maintenance.
- Medical expenses; and
- Lump sum compensation.
The period for claiming claim weekly payments and medical expenses under the RTW Act is summarised in the table below.
|Entitlement period ends|
|Date injured||Category||Income maintenance||Medical expenses|
|Before 1 July 2015 (but after 30 September 1987)||Existing injury||1 July 2017||The date when weekly payments have not been received for 12 consecutive months, but no later than 1 July 2018.|
|On or after 1 July 2015||104 weeks (2 years) after injury||The date when weekly payments have not been received for 12 consecutive months.|
Weekly payments can be claimed for any period when a work injury or condition has caused an incapacity for work within the entitlement period.
For a worker with an existing injury, the entitlement to weekly payments reset on 1 July 2015. This means that an injured worker can claim weekly payments under the RTW Act for a maximum of 104 weeks, that is until 1 July 2017, irrespective of how long he or she was receiving weekly payments under the old scheme. The end of the entitlement period for these workers is fast approaching. Unfortunately, payments cannot be extended after 1 July 2017 even if the worker is still incapacitated for work because of the same injury or condition.
For a worker who was injured on or after 1 July 2015, the entitlement to claim weekly payments ends 104 weeks after the injury occurred. For example, a worker who was injured on 9 October 2015 can claim weekly payments until 8 October 2017. Payments cannot be extended thereafter for the same injury or condition.
For a worker who remains incapacitated for work after the entitlement period ends he or she may need to consider a return to some form of work or otherwise to seek an alternative form of income. Many injured workers will be forced to transition from worker’s compensation payments to a Commonwealth benefit such as a NewStart allowance or disability support pension from Centrelink. Rarely will an injured worker be better off receiving a Commonwealth benefit compared with weekly payments through worker’s compensation. It is therefore important that an injured worker consider alternative sources of income or compensation well before the entitlement ends.
Alternative sources of income or compensation include:
- Lump sum payment for non economic and/or economic loss, where the injury is causing at least a 5% whole person impairment.
- Income protection (weekly payments) through superannuation, if applicable.
- Lump sum payment through superannuation for total and permanent disability, if applicable.
- Financial hardship payment through superannuation, if applicable.
Whether or not your income support is coming to an end on 1 July it is important that you seek advice about your worker’s compensation claim and entitlements. You may be entitled to compensation which you are not aware about. Turner Freeman can assist in both worker’s compensation and superannuation claims.
An injured worker can claim the costs of reasonable medical and other like expenses associated with an accepted injury or condition. Costs that can be claimed include pharmaceuticals, rehabilitation services (e.g. physiotherapy), medical and hospital attendances and travel costs. In a further blow to injured workers however, the entitlement to claim medical expenses has been capped under the RTW Act. Under the old scheme reasonable medical expenses could be claimed ongoing. Under the RTW Act the period for claiming medical expenses is closely related to how long an injured worker receives weekly payments (or has an entitlement to receive them).
For a worker with an existing injury who was not receiving (or not entitled to receive) weekly payments when the new law commenced on 1 July 2015, the entitlement to claim medical expenses ended on 1 July 2016. Where a worker with an existing injury was receiving (or was entitled to receive) weekly payments on 1 July 2015, medical expenses can be claimed in the same period as weekly payments are being received and in the period when 12 consecutive months has elapsed since the last payment. The entitlement to claim will end on or before 1 July 2018.
For a worker who was injured on or after 1 July 2015, medical expenses can also be claimed in the same period as weekly payments are being received, and in the period when 12 consecutive months has elapsed since the last payment.
Once the entitlement to claim medical expenses expires the insurer is not required to pay for an injured worker’s medical or like expenses, even if the costs and reasonable and necessary. It is anticipated that many injured workers will transition to services funded by Medicare, which will likely involve long waiting lists. Alternatively, injured workers will need to fund their own expenses privately or claim through a private health fund, if applicable.
There are limited exceptions, including for seriously injured workers and when claim is made for future surgery or therapeutic appliances, including hearing aids. For more information on seriously injured worker entitlements and claiming therapeutic devices (hearing aids) please search for earlier blogs in the worker’s compensation section.
Every injured worker should seek advice about their claim and entitlements. The first step is to arrange a free, no obligation first consultation with one of our lawyers.
Turner Freeman can act for you in relation to any aspect of your workers compensation claim, including a claim for lump sum compensation. Contact us on 8213 1000 to arrange an initial free, no obligation discussion with one of our personal injury lawyers.