In New South Wales, workers who sustain injuries or fall ill while on the job may be entitled to workers’ compensation benefits provided by their employer’s insurance company. However, navigating the process of making a workers’ compensation claim can be complex. This article aims to help workers better understand the process of claiming workers compensation.
Below is a summary of the topics covered in the article:
- How to claim workers compensation in 7 easy steps
- The time frames in making a workers compensation claim
- What happens once you’ve submitted your claim
- Your entitlements upon a successful claim
- How long it takes to reach a decision on a claim
- What you can do if your workers compensation claim is rejected
7 steps to making a workers compensation claim in NSW
Making a workers compensation claim can be a complicated process, but it is essential to get the compensation you deserve. Here are seven steps to making a workers compensation claim in NSW:
- Gather evidence about your injury
- Notify your employer about your injury immediately
- Notify the insurer about your injury
- Retrieve your Workers Compensation Claim number
- Seek medical treatment from your doctor
- Obtain a “certificate of capacity from your doctor
- Submit workers compensation claim form
1. Gather evidence about your injury
When claiming workers’ compensation in NSW, gathering evidence is crucial to the success of your claim. The more evidence you are able to gather about your injury, the more likely it is that your claim will be successful.
One important piece of documentation to record is the ‘register of injuries’. This register should include the name, address, age, occupation, industry, time/date, nature, and cause of the injury. Other evidence may include witness statements, photographs of the injury, and any documents relating to your employment.
2. Notify your employer about your injury immediately
If you have suffered a work-related injury or illness, it is important to notify your employer immediately. The NSW workers compensation scheme requires that you report the injury within 48 hours of the incident. Failure to report promptly may result in delays in receiving your compensation entitlements, or even a denial of your claim.
When reporting the injury, you will need to provide details such as the location, cause, and nature of the injury. Your employer will then give you a claim number which you will need for any future correspondence regarding your claim.
3. Notify the insurer about your injury
Once you have notified your employer about your work injury, the next step is to notify the insurer. This will help ensure that your claim is processed as soon as possible.
You can now notify iCare directly about your work injury. You can do this by calling their hotline 13 77 22 or submitting an online form.
As per SIRA’s Workers Compensation Guidelines the notifications can be given to the insurer by the worker, the employer or by some other person (for example, a medical practitioner) acting for or on behalf of the worker or the employer.
4. Retrieve your Workers Compensation Claim number
After reporting your work injury to the insurer, you will be assigned a Workers Compensation Claim number. This number will be used for all correspondence related to your claim, so it’s important to retrieve it as soon as possible.
5. Seek Medical Treatment from your doctor
Your doctor will then assess the injury and recommend any necessary treatments. These recommended treatments should be reasonable and necessary, taking into account the nature and severity of the injury and your capacity to work. It is important to follow the treatment plan outlined by your doctor, including any referral to specialists or rehabilitation services.
6. Obtain a ‘Certificate of Capacity’ from your doctor
Obtaining a Certificate of Capacity from your doctor is an important step in claiming workers’ compensation in NSW. This certificate outlines the nature of your injury or illness, your capacity to work, and the treatment you require in order to determine if you are eligible for workers compensation.
7. Submit workers compensation claim form
You can obtain a claim form from your employer or by visiting SIRA’s website. Fill out the form completely and ensure that all details are accurate and up-to-date. Once the form is complete, attach a copy of your certificate of capacity and submit it to your employer.
It is important to note that submitting a simple injury notification form can also provide workers with provisional support such as weekly compensation payments and medical treatment for up to 12 weeks, without the need to submit a full claim form.
How long do I have to lodge a Workers Compensation claim?
When it comes to lodging a claim for workers compensation in NSW, time is of the essence. According to Section 261 of Workers Compensation Act 1998 the recommended timeframe for lodging a claim is within six months of the injury or the onset of a medical condition caused by work. However, if this timeframe is missed, you can still submit a claim up to three years after the incident if you can show reasonable cause for delay.
What happens once I’ve submitted a Workers Compensation claim?
Once you have submitted a workers compensation claim in NSW, the insurer has 21 days from the date of receipt of your claim to make a decision on whether to accept or reject it. If more information is required, they may request additional evidence, which can extend the decision timeline. This assessment may involve seeking medical evidence from your doctor or specialist, as well as details from your employer about the circumstances of your injury.
The relevant workers compensation insurer is obliged to start provisional payments within 7 calendar days unless there is a reasonable excuse not to. So, if the insurer has not issued you a reasonable excuse notice, you can expect to start receiving provisional weekly payments within 7 days.
If your claim is accepted, you may be entitled to a range of benefits, including weekly payments to cover loss of income, payment of medical treatment and expenses, and potentially a lump sum payment if you have a permanent impairment. The amount of entitlements will depend on the particular circumstances of your injury and the extent of your impairment.
What are my entitlements under Workers Compensation?
Weekly payments under workers compensation
Under the workers compensation scheme, weekly payments are available to individuals who suffer a work-related injury or illness. These payments are designed to replace lost wages and help injured workers cover their living expenses while they recover.
Workers who experience a compensable injury or illness are entitled to weekly payments for at least the first 13 weeks of their incapacitation, regardless of whether they return to work. After that initial period, entitlement to weekly benefits is subject to ongoing assessment.
After the first 13 weeks, workers are entitled to weekly compensation payments for loss of income for up to 130 weeks. For more information on the weekly payments visit our Weekly Payments for Workers Compensation Guide.
Medical and rehabilitation expenses
Workers who experience a work-related injury or illness may be entitled to reimbursement for medical and rehabilitation expenses. These expenses can include doctor’s visits, hospital stays, medication, physiotherapy, and more.
However, insurance companies must consider whether these expenses are “reasonable and necessary” before approving them. Some factors that influence this decision include the severity of the injury, the expected duration of treatment, and the potential impact of the treatment on the worker’s ability to return to work.
Exceptions to the “reasonable and necessary” rule may apply in some cases. For example, if surgery is required to treat the injury or illness, it may be covered regardless of whether it meets the usual criteria. Additionally, if the worker’s condition has not yet stabilized, ongoing treatment may be covered until it does so.
Lump Sum Compensation
Workers are also eligible for lump sum compensation if they meet the minimum threshold for whole person impairment. The thresholds for this include 11% for physical injuries and 15% for psychological injuries. The lump sum compensation is paid in addition to the weekly payments and medical and rehabilitation expenses covered by workers compensation.
For more information regarding the amount of compensation you can receive, visit our Workers Compensation Payout Guide for NSW.
Provisional Liability
While the relevant workers compensation insurer assesses the claim, workers may be eligible for Provisional Liability. This means the worker is to be paid weekly payments for up to 12 weeks and payment of medical expenses up to $10,000 until a decision has been made on the outcome of the claim. Provisional payments will commence within 7 calendar days of the injury being notified unless there is reasonable excuse not to.
However, please be aware that a reasonable excuse may apply to provisional weekly payments but not to medical payments. What this means is that upon receipt of the injury notifications, the insurer might be able to delay started paying weekly payments by applying reasonable excuses in certain circumstances, but they cannot delay paying for medical and hospital expenses.
Uninsured employers can also trigger Provisional Liability. If an employer does not have workers’ compensation insurance, they still must admit liability for the employee’s injury or illness. The employer can then be held liable for any costs associated with the claim.
For more information, visit our article on Understanding Provisional Liability in Workers Compensation.
Common reasonable excuses
One of the most common reasonable excuses is that they have not received sufficient medical information. If this happens, you just need to provide them with your medical documents such as a workers compensation certificate of capacity or other medical records which can show that a work-related injury has occurred.
If the insurer has issued a reasonable excuse within the 7 days, you then need to complete a claim form. They will explain in the notice why provisional weekly payments has been delayed and include the details of the reasonable excuse they have applied. A claim form normally comes together with their reasonable excuse notice for you to complete and return, and you will also be advised how to make a claim.
How long does it take to make a decision on my claim?
In NSW, a decision on a workers compensation claim is usually made within 21 days of it being lodged. However, more complex cases may take longer. If the insurer requires additional information to make a decision, they must advise the claimant of this within seven days of receiving the claim.
Once the completed and duly signed claim form is received by the insurer, they have 21 days to either accept provisional liability for weekly payment for up to 12 weeks, or accept liability, or dispute liability.
It is recommended that claims be lodged as soon as possible after the injury or illness occurs, with a maximum timeframe of six months. Seeking legal advice early in the process can also be beneficial, as it can help ensure the claim is being handled correctly and the claimant is receiving their entitlements.
What happens when my claim is rejected?
If your workers’ compensation claim is rejected, there are a few steps you can take. The first step is to review the Section 78 notice that the insurer is required to provide when declining a claim. This notice should outline the reasoning behind the rejection.
If you disagree with the insurer’s decision to reject your claim, you may want to consider disputing the decision. Contacting a workers’ compensation lawyer can help you determine your options for disputing the rejection and taking legal action.
Having legal representation can make a significant difference in the outcome of your dispute. A workers’ compensation lawyer can help you build a case to show that your injury is work-related and that you are entitled to compensation for medical expenses and lost wages.
How Alliance Compensation & Litigation Lawyers can help
Claiming Workers Compensation in NSW can be quite complex, navigating this area can be overwhelming and stressful. Our skilled Workers Compensation Lawyers at Alliance Compensation & Litigation Lawyers can help you throughout the process and ensure you are supported along the way.
For more information on Workers Compensation, visit our complete Workers Compensation Guide.
Book a free consultation today or call us at (02) 8764 1776.
