5 frequently asked questions in workers comp claims

1. What is workers compensation?

The acts also outlines the rights and responsibilities on both the injured worker and the employer to ensure the injured worker is provided with benefits and assistance to recover and return safely to work.

2. How do I make a workers compensation claim?

If you have sustained an injury in the course of employment you must undertake the following steps:

Step 1. Notify the employer of the injury as soon as possible

Step 2. Record the injury in the employer’s register of injuries

Step 3. Obtain a Work Cover Medical Certificate of Capacity from your general practitioner or hospital

Step 4. Notify the insurer of the injury (the insurer’s details are obtained from the employer who must provide the name when requested)

Step 5. Ensure that the Work Cover Certificate of Capacity and all Medical bills or expenses are given to the employer and a copy to the insurer

Once the scheme agent/insurer has been notified of an injury, the following will occur:

• The insurer will contact the worker and employer;
• The insurer will review the claim and commence provisional liability payments which must start within 7 days of receiving notification of the injury

If the insurer has a reasonable excuse not to commence provisional liability payments the insurer must notify the worker within 7 days of receiving the notification of injury.

A claim form is only required if:

• The insurer has a reasonable excuse not to commence provisional liability payments
• Weekly payments exceed the 12 week provisional liability period
• Provisional expenses exceed $7500 and there is not sufficient information to determine ongoing liability
• The injury has been notified but there is insufficient information to determine liability

3. Is there a time limit for making a workers compensation claim?

A claim for Workers Compensation should be made as soon as possible following an injury or otherwise within 6 months of the injury, accident or death.

If there is a failure to make a claim within 6 months and that failure is the result of ignorance, common mistake or absence from the State then a claim for workers compensation can still be made.

If the claim is not made within 3 years of the date of injury, accident or death, then the claim cannot be made unless the injury resulted in the death or serious injury of the worker.

4. When my claim is accepted what benefits do I receive?

If the insurer accepts liability for your claim then you will receive benefits under the Workers Compensation Act.

The major benefits include:

• Payment of weekly compensation
• Payment of lump-sum compensation for permanent impairment
• Medical and Hospital expenses

Other benefits payable are;

• Rehabilitation expenses
• Death benefits and funeral expenses
• Compensation for damage to property (e.g. clothing)

5. What is lump sum compensation for permanent impairment?

An injured worker may obtain a lump sum amount of compensation if they have sustained a permanent impairment as a result of the injury which occurred in the course of employment.

A permanent impairment is an injury that has stabilised and has resulted in an impairment that is unlikely to change within the next 12 months.

To determine if you are entitled to a lump sum amount of compensation for permanent impairment you are assessed by an independent medical examiner known as an AMS. The AMS makes an assessment of the whole person impairment using guidelines established by the WorkCover Authority of NSW.

You must obtain an assessment of greater than 10% whole person impairment to be eligible to obtain lump sum compensation for permanent impairment.

If you are eligible for lump-sum compensation for permanent impairment this is payable in addition to any benefits you are entitled to receive for weekly payments and medical expenses.

For more information, review our Workplace Compensation Claim Success guide here.