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Home | Blog | Medical Expenses Entitlements

At Turner Freeman Lawyers we specialise in all types of Worker Compensation claims. We have assisted many hard-working people who have unfortunately been injured during the course of employment, gain access to their weekly, medical and lump sum compensation entitlements.

The NSW Workers Compensation scheme is a difficult and demanding system for injured workers to navigate. Often in circumstances where workers suffer an injury they find themselves requiring extensive, ongoing and at times, costly treatment. More often than not, these injuries require treatment outside the time period permitted by the Workers Compensation Act 1987.

Prior to the Workers Compensation Amendment Bill 2015, workers assessed as suffering from less than 30 percent permanent impairment were limited to one year of ongoing medical expenses following the cessation of a workers entitlement to weekly compensation payments. This would often see injured workers being required to pay for ongoing treatment in situations where their condition has impacted on their day to day lives but has not been deemed severe enough to satisfy a medically assessed threshold.

To address these difficulties that are often encountered by the injured worker, the Workers Compensation Amendment Bill 2015 has extended the rights and entitlements of the injured worker.

Medical Expenses Entitlements

Most importantly the previous cap on medical expenses has been amended to reflect a level of treatment that is now sufficient for an injured worker.

The Workers Compensation Amendment Bill 2015 has resulted in the following amendments being introduced:

  • All workers are entitled to Two years on-going medical expenses following cessation of weekly payments
  • Workers assessed as suffering 11-20 percent whole person impairment are entitled to 5 years paid medical expenses.
  • Workers assessed as suffering 21 percent or greater are classed as Workers with high needs and are entitled to lifetime medical expenses.
  • Secondary surgery is now more accessible.

What this means?

To understand how this may change your entitlement, consider the following example:

John, a carpenter during the course of employment suffered disc bulges of the lumbar spine due to ongoing heavy lifting. John made a claim for workers compensation, was off work and eventually required a lumbar spine discectomy to correct ongoing pain in his lower back.

He was assessed as suffering 21% whole person impairment. He has since re-trained and returned to work in a different role. John occasionally suffers pain flare ups, consults a chiropractor on a regular basis and requires analgesia to treat the occasional flare ups.

Previously, under the Workers Compensation Act 1987 Johns entitlement to paid medical expenses had expired.

Under these new amendments John is considered a worker with high needs and is thus entitled to ongoing medical expenses for life.

Secondary surgery

Further, if your injury has since deteriorated since your claim or if you have developed a consequential injury since your initial injury, you may now have an entitlement to pursue approval of secondary surgery to that injured body part. To prove that you are entitled to this secondary surgery, the surgery must:

  • Be directly consequential to the previous injury/surgery
  • Affect the body part that the surgery was performed on
  • And be approved by the insurer within 2 years of the earlier surgery.

Previously, surgery benefits were subject to a limitation period of 12 months following weekly payments ceasing.

Artificial Aids, Home and Vehicle Modifications

The amendments under the Workers Compensation Amendment Bill 2015 now further entitles workers who require artificial aids, home and vehicle modifications following injury to lifetime compensation for these expenses. As such, injured workers who require:

  • Prosthetics
  • Crutches
  • Eyes or teeth
  • Hearing aids and batteries
  • And other modifications are entitled to coverage of these medical expenses for life.

Prior to these amendments, workers who suffered less than 31% whole person impairment were precluded from coverage of these expenses, following 12 months after weekly compensation payment had ceased. As such, if you are a worker who requires any home/car modification, prosthetic or artificial aid you may be entitled to further medical and treatment expenses.

How we can help

If you are an injured worker who has been assessed as suffering from 11% whole person impairment or greater, have been recommended secondary surgery or require artificial aids, or home/vehicle modification following injury we encourage you to contact our office to discuss your possible further entitlements. To speak with one of our experts or accredited specialists in New South Wales please call 13 43 63. Our offices are located in SydneyParramatta, Campbelltown, Newcastle, Penrith, Wollongong and Gloucester.

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