Complete Guide to Workers Compensation NSW

This Workers Compensation guide aims to provide a clear and concise understanding of workers compensation in NSW

This Workers Compensation guide aims to provide a clear and concise understanding of workers compensation in NSW including:

  • An overview of Workers Compensation in NSW,
  • Understanding NSW Workers Compensation legislation & guidelines
  • Types of injuries and illnesses covered
  • Process of claiming Workers Compensation
  • Benefits available to injured workers
  • Time limitations of claiming workers compensation
  • Understanding work capacity, injury management consultants, & injury independent medical assessments

What is Workers Compensation?

Workers compensation in NSW is a crucial system that provides support and benefits to workers who have been injured, become ill, or suffered disabilities due to work-related activities. In New South Wales (NSW), the workers compensation scheme plays a vital role in ensuring the well-being of employees and providing them with financial assistance, medical treatment, and rehabilitation services.

According to Safe Work Australia’s findings, during the 2019-20 fiscal year, Australia witnessed a total of 120,355 significant workers’ compensation claims. Out of these claims, 31% pertained to illnesses and diseases. The occupational categories that demonstrated the highest rates of serious claims were laborers, machinery operators and drivers, as well as community and personal service workers.

Is it WorkCover or Workers Compensation?

WorkCover, although often used interchangeably with workers compensation, is the previous name for workers compensation in NSW. Since 2015, three new entities under SafeWork NSW manage the scheme’s payments and regulations. While some people still refer to it as WorkCover, it’s essential to understand that both terms essentially refer to the same scheme. This guide will use the term “workers compensation” throughout to avoid any confusion.

How Does Workers Compensation Work In Sydney?

Workers compensation in Sydney operates within the framework of NSW legislation and regulations. It functions as a system to provide financial support and assistance to workers who have been injured or become ill due to their work activities.

Under the NSW workers’ compensation scheme, injured workers in Sydney are entitled to a range of benefits, including lump sum payments, weekly payments for lost earnings, and reimbursement of medical expenses. Before submitting a claim, it is crucial to follow specific steps, such as notifying your employer and gathering evidence to support your claim.

NSW Workers Compensation Legislation & Regulations:

Workers Compensation Act 1987Primary legislation governing workers’ compensation in NSW, establishing rights and responsibilities of employers and employees.
Workplace Injury Management and Workers Compensation Act 1998Provides a framework for injury management, return to work, and compensation for work-related injuries.
Workers’ Compensation (Dust Diseases) Act 1942Covers compensation for workers suffering from dust-related diseases, such as asbestosis and mesothelioma.
Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987Specifically addresses workers’ compensation for bush fire, emergency, and rescue services personnel.
Workers Compensation Regulation 2016Detailed regulations and guidelines for the implementation of the Workers Compensation Act, covering various aspects.
Workers Compensation (Dust Diseases) Regulation 2018Provides specific regulations related to compensation for dust-related diseases under the Workers Compensation Act.
Workers Compensation (Bush Fire, Emergency and Rescue Services) Regulation 2017Specific regulations related to workers’ compensation for bush fire, emergency, and rescue services personnel.
Source: https://www.sira.nsw.gov.au/workers-compensation-claims-guide/legislation-and-regulatory-instruments/legislation,-acts-and-regulations

Workers compensation guidelines for NSW

Workers compensation guidelines in NSW serve as a framework to ensure that all parties involved in a claim for workers compensation understand the process and their rights. These guidelines outline essential steps in the process, including the notification requirements, dispute resolution procedures, and the obligations of all parties involved:

  1. Initial notification of an injury: Outlines the requirements and process for promptly notifying the employer about a work-related injury or illness.
  2. Provisional liability: Explains the circumstances under which an insurer can accept provisional liability for certain benefits before making a formal determination of the claim.
  3. Making a claim: Provides information on the steps involved in making a claim for workers’ compensation, including the required documentation and timelines.
  4. Compensation for medical, hospital, and rehabilitation expenses: Details the entitlements and guidelines for compensating medical, hospital, and rehabilitation expenses incurred due to a work-related injury or illness.
  5. Work capacity Assessment: Describes the process of assessing a worker’s capacity to work and the factors considered when determining their ongoing entitlement to compensation.
  6. Injury management consultants: Explains the role and responsibilities of injury management consultants in facilitating the recovery and return to work of injured workers.
  7. Independent medical examinations and reports: Provides guidance on conducting independent medical examinations and preparing comprehensive reports to assess the worker’s condition and progress.
  8. Lump sum compensation: Covers the criteria and process for determining eligibility for lump sum compensation payments for permanent impairment resulting from a work-related injury or illness.
  9. Commutation of compensation: Outlines the conditions and process for converting periodic compensation payments into a lump sum payment based on the worker’s circumstances.
  10. Pre-injury average weekly earnings: Explains how the pre-injury average weekly earnings are calculated and used as a basis for determining the compensation entitlements for injured workers.

For detailed information on the workers compensation guidelines, please refer to the official website of the State Insurance Regulatory Authority (SIRA) in NSW.

Source: https://www.sira.nsw.gov.au/workers-compensation-claims-guide/legislation-and-regulatory-instruments/guidelines/workers-compensation-guidelines

What types of injuries/illnesses are covered by Workers Compensation NSW?

Physical Injuries and Illnesses

Workers’ compensation in Sydney covers various types of physical injuries and illnesses that result from work-related activities. When filing a claim, it is crucial to provide the necessary forms and detailed information regarding the injury or illness. Medical expenses and domestic assistance related to the injury or illness may be covered under the scheme.

According to iCare the most common work related physical injuries we often see in NSW include:

  • Slips, trips, and falls are the most common workplace injuries, often resulting in back, leg, hip, and foot injuries such as fractures, bruises, cuts, and dislocations.
  • Overexertion and muscle strains are frequent among workers who lift heavy objects or perform repetitive motions, particularly affecting the back and neck.
  • Contact with equipment and objects poses risks like being struck by equipment or caught in machinery, especially in industries such as construction, manufacturing, and transportation.
  • Crashes or collisions can lead to serious injuries for workers operating vehicles or machinery.
  • Workers handling sharp tools or working with sharp objects are at risk of cuts and lacerations.

Mental Health Conditions and Psychological Injuries

The workers’ compensation scheme in Sydney also recognizes mental health conditions and psychological injuries that are caused by work-related factors. Approved injury management consultants (IMCs) play a vital role in facilitating progress towards worker recovery and optimizing health and work outcomes.

Occupational Diseases and Infections

Workers’ compensation in Sydney covers occupational diseases and infections that arise from work-related exposures. These can include diseases caused by prolonged exposure to specific substances or environments, such as asbestos-related diseases or hearing loss from noisy workplaces. Infections resulting from exposure to bacteria or viruses in the workplace, including tuberculosis or COVID-19, may also be covered. Other conditions deemed work-related, such as dermatitis or respiratory issues, may qualify for compensation.

How to file for workers compensation

When it comes to filing for workers’ compensation, understanding the necessary steps and procedures is crucial. This section will guide you through the process, from notifying your employer about the injury or illness to filling out the workers’ compensation claim form accurately and gathering the essential evidence to support your claim.

How to apply for workers compensation in NSW?

To apply for workers compensation in NSW, it is advisable to contact an experienced workers compensation lawyer who can guide you through the process. Our lawyers at Alliance Compensation & Litigation Lawyers will assist you in gathering evidence to support your claim and send a notice of claim to the other party.

If an agreement cannot be reached, court proceedings may be initiated. It is crucial to gather all relevant documents and information, as well as understand the types of compensation you may be entitled to, such as lost income, medical expenses, and rehabilitation services.

How do I fill in the NSW workers compensation claim form?

To properly fill out the NSW workers compensation claim form, ensure you have all the necessary information related to your injury at hand. The form will require details about your injury or illness, medical treatment received, and time missed from work.

It is essential to be detailed in providing information and include any supporting evidence, such as medical reports or witness statements. Remember to provide accurate contact information and relevant job details to facilitate the claim process.

How To Make a Successful Claim in Sydney?

Gathering Evidence to Support Your Claim

Before making a claim for workers compensation, it is crucial to gather all necessary evidence. This includes obtaining medical records, accident reports, witness statements, and documenting expenses related to the injury. Eligibility for compensation often requires proving that the work injury was a direct result of employer negligence, meeting the minimum permanent impairment assessment, and receiving all statutory lump sum entitlements.

Notify your employer immediately

In NSW, it is important to notify your employer about a work-related injury as soon as possible, either verbally or in writing, within three months of its occurrence. The employer must then inform their insurer within 48 hours of the incident. When notifying your employer, provide them with contact details, insurance information, treating doctor’s details, and a description of the injury and how it occurred.

Seek medical treatment

If your injury or illness requires medical attention, you should seek treatment from a medical professional as soon as possible. This can help to ensure that you receive prompt and appropriate treatment and that your injury or illness is documented in your medical records. Your nominated treating doctor will issue you with a certificate of capacity which is a required document when lodging a workers compensation claim.

Lodge a claim

To make a claim for workers’ compensation, you need to complete and submit your claim form as soon as possible. You should provide all the necessary documentation in support of your claim, such as medical reports and witness statements. Our experienced lawyers at Alliance Compensation & Litigation Lawyers can help you lodge a workers compensation claim.

Attend medical appointments

If you are required to attend medical appointments, it is important that you attend all appointments as scheduled. This can help to ensure that you receive the appropriate treatment for your injury or illness and that your condition is properly assessed.

Cooperate with your employer and the insurer

You should cooperate fully with your employer and the insurer throughout the claims process. This may involve attending medical appointments or providing additional information about your injury or illness.

Work with Lawyers

Working with experienced lawyers specializing in workers compensation can greatly increase the chances of a successful claim. They can help you gather the necessary evidence, negotiate with the other party or insurer, and guide you through the legal process. In case of a dispute, your lawyer will provide representation and ensure your rights are protected. At Alliance Compensation & Litigation Lawyers, we offer a no-win-no-fee approach to make the legal process accessible to all.

Receive Compensation Payout

Upon a successful claim, various types of compensation payouts may be available. These can include weekly payments for lost earnings, lump-sum payments for permanent impairment, and reimbursement for medical expenses. The specific eligibility criteria for each payout may vary, and the responsible agencies managing the workers’ compensation payouts should be identified based on the nature of the workplace injury or illness. For more information, visit our Workers Compensation Payout Guide.

What do I do if the claim is rejected?

If your workers compensation claim is rejected, it is important to take appropriate steps to dispute the rejection. Your insurer will provide a Section 78 Notice outlining the reasons for the rejection. Seeking legal representation is crucial to navigate the dispute process effectively. You may need to provide additional evidence or information to support your claim, and it is essential to carefully review the reasons for rejection and address each point in your dispute.

When Can an Injured Worker Make a Claim Under the Scheme?

Injured workers in Sydney can make a claim under the Workers Compensation Scheme when they sustain an injury or illness arising out of or in the course of their employment. The injury or illness can be physical or psychological, and it should be caused by work-related duties or activities.

Notification to the employer or insurer should occur within 60 days of becoming aware of the injury. Additionally, the worker must have been employed at the time of the injury or illness and be covered by a workers compensation insurance policy.

What is the time limit in claiming Workers Compensation in NSW?

Reporting the injury to your employer:

  • It is crucial to inform your employer about the injury within two months of its occurrence.

Filing a workers’ compensation claim:

  • While you should ideally inform your employer within 60 days of the injury, you have up to six months to file a claim.
  • Failing to file within this timeframe may result in the claim being deemed barred.

Exceptions for filing a claim after the deadline:

There are three circumstances where a claim can be filed beyond the six-month deadline:

  1. If you were absent from the state.
  2. If you were unaware of the injury and only filed a claim once you became aware.
  3. If there was a mistake or misunderstanding regarding what you are eligible to claim for.

Types of Benefits Injured workers are entitled to

Lump Sum Payments for Permanent Impairment Payouts

Workers who have suffered permanent impairments in Sydney may be entitled to receive lump-sum compensation payments as part of the workers’ compensation scheme. The eligibility criteria for these payments include meeting specific requirements for permanent impairment and work injury damages caused by negligence.

Insurers assess the claimant’s entitlement based on relevant particulars outlined in the legislation. These lump sum payments provide compensation for the long-term impact of the injury or impairment.

Read out guide on Whole Person Impairment to understand more about permanent impairment lump sum compensation.

Lump Sum Payments for Work Injury Damages

If a worker has been injured at work as a result of an employer’s negligence then they may be eligible to receive a lump sum compensation payment also. However there are certain criteria that must be met in order for the worker to claim Work Injury Damages.

For more information read our article on Work injury Damages: Injured due to Employer Negligence.

Weekly Payments for Loss of Earnings or Wages During Recovery Periods

When an employee is unable to work and loses income due to a work-related injury or illness, workers’ compensation in Sydney can provide weekly payments to cover the lost wages. The eligibility and duration of these payments depend on the severity of the injury and the estimated recovery time.

The insurer determines the amount based on medical certification and documentation from the employee’s doctor. It is important to keep the employer and insurer informed of any changes in work capacity and provide regular medical updates.

Reimbursement for Medical Expenses Related to Work-Related Injury or Illness

Under the workers’ compensation scheme, injured workers in Sydney may be entitled to reimbursement for medical expenses related to their work-related injury or illness. To receive reimbursement, the treatment must meet the definitions described in the relevant legislation.

Workers can claim expenses for necessary medical treatments and services, including hospitalization and rehabilitation. Pre-approval from the insurer is typically required, except for treatments exempted under the Guidelines. Provisional liability for medical expenses can be accepted by the insurer for up to $10,000 before a formal determination of liability is required.

For more information on how much compensation you can receive, visit our Workers Compensation Payout Guide for NSW.

Domestic Assistance for Household Tasks, If Required

Workers’ compensation in Sydney recognizes the need for domestic assistance for household tasks in certain cases. A domestic assistance care plan is established with the injured worker and their medical practitioner, outlining the specific requirements for assistance.

The plan may include services such as cleaning, meal preparation, and personal care. Providers of gratuitous domestic assistance can submit a diary of the services performed to facilitate the reimbursement process. The care plan should meet minimum requirements as specified in the guidelines.

Provision of Appropriate Medical Treatment and Specialists

The workers’ compensation scheme in Sydney emphasizes the provision of appropriate medical treatment and access to specialists for injured workers. Insurers determine what medical treatment is reasonably necessary for the injured worker’s recovery. Qualified medical practitioners and specialists play a crucial role in assessing, diagnosing, and treating work-related injuries and illnesses.

For specific conditions, such as hearing impairment loss injury, ENT specialists provide assessment and treatment. Independent medical examiners may be involved in assessing and examining workers’ conditions to ensure fair evaluation and appropriate treatment.

Example of a successful NSW workers compensation settlement

Our client was in his late 50s when he suffered a work-related injury in the construction industry, leaving him uncertain about his future. The legal team at Alliance Compensation Lawyers assisted the client in claiming statutory benefits, including weekly compensation for wage loss and coverage for medical expenses.

Efforts were made to pursue a lump sum claim for impairment benefits, despite challenges such as surgery and disagreement on the impairment rating. The team successfully presented the case before the Workers Compensation Commission, securing a rating above the threshold for further entitlements and the right to pursue a Common Law claim.

Despite the case being beyond the limitation period, the legal team persevered and successfully finalized a Work Injury Damages/Common Law Negligent claim. The client received overall compensation exceeding $600,000, including weekly compensation, medical expenses, a lump sum claim for impairment, and damages from the Common Law proceedings. 

How long can you be on Workers Compensation in NSW?

You can be on Workers Compensation for a maximum of 5 years. Nevertheless, if you have a permanent impairment exceeding 20% and have been determined unable to work indefinitely, the five-year limit no longer holds. In New South Wales, your weekly workers’ compensation payments will persist until you can resume work, reach a settlement for work injury damages, or have received payments for five years (unless your permanent impairment exceeds 20% and you have been assessed as being unable to work indefinitely).

The duration of workers compensation payments in NSW varies depending on individual circumstances. Factors such as the severity of injuries, lost earnings, and the impact on future earnings are considered when determining the length and amount of compensation. Expert medical assessments, in conjunction with income loss assessments, play a crucial role in calculating compensation.

Is superannuation payable on workers compensation in NSW?

Superannuation is generally not payable on workers compensation payments in NSW. Workers compensation benefits are separate from superannuation contributions. However, there are exceptions and specific circumstances where superannuation contributions may be payable while on workers compensation.

Factors such as modern awards, enterprise agreements, and partial work capacities can impact superannuation entitlements. It is recommended to consult with a workers compensation lawyer or financial advisor to understand the specific rules and regulations regarding superannuation while on workers compensation.

To learn more about this, read our article on Superannuation & Workers Compensation.

What is the maximum payout for workers compensation in NSW?

The maximum payout for workers compensation in NSW can vary depending on the circumstances of the case. Factors such as the nature and severity of the injuries, impairment levels, and the impact on an individual’s earning capacity are taken into account when determining the maximum compensation amount.

For specific details regarding the maximum payout for your case, it is advisable to consult an experienced workers compensation lawyer who can provide accurate information based on the relevant legislation and precedents. However, it is noted by SIRA that the maximum weekly compensation in NSW from April 2023 to September 2023 is $2,395.30. In certain cases, workers may receive compensation until reaching retirement age or if they are unable to return to work due to the injuries sustained.

What is a Work Capacity Assessment?

Work capacity assessments play an essential role in determining an injured worker’s capacity to work and their eligibility for compensation. These assessments are conducted based on available information or by gathering additional information if necessary. This assessment is typically used to help with work capacity decisions, however, it’s not necessary under Section 44(A)(3).

It is crucial to keep a record of work capacity assessments in the worker’s file, as they inform decisions regarding compensation and work arrangements. It’s also important to note that Work capacity assessments are conducted throughout the life of a claim when new information is received.

Workers Compensation with some work capacity

Workers who have some work capacity may still be eligible for weekly payments under the workers’ compensation scheme in Sydney. The amount of these payments increases to 95% of pre-accident earnings if the worker is working at least 15 hours per week and earning a minimum of $200 per week. Some exceptions apply, and exempt workers are not required to undergo a work capacity assessment.

Workers Compensation with no work capacity

Workers who have no work capacity due to their injuries may be eligible for weekly payments for a specified period. In the first 13 weeks, the payments are generally 95% of pre-accident earnings. From week 14 to week 130, the payments may reduce to 80% of pre-accident earnings.

After 130 weeks, the eligibility for weekly payments may depend on meeting specific criteria, such as having a whole-person impairment of at least 20% and being unlikely to work again. It is important to consult with an experienced workers compensation lawyer to understand the specific conditions and criteria for no work capacity claims.

Why do I need an Injury management consultant?

Injury management consultants play a crucial role in facilitating the recovery and return to work of injured employees. These consultants, who are approved by the workers compensation scheme, assess the worker’s situation, discuss possible solutions with all relevant parties, and provide guidance throughout the recovery process. However, it’s important to note that the functions of injury management consultants do not include making decisions on liability or compensation entitlements.

What are Independent medical examinations?

Independent medical examinations (IMEs) are assessments conducted by qualified medical practitioners to assist in injury or claims management. Insurers may require injured workers to attend IMEs as part of the workers’ compensation process.

The Guidelines specify the requirements for arranging IMEs, including the qualifications and expertise of the examiners. It is mandatory for insurers to fulfill certain obligations when requiring a worker to attend an IME. Subsequent IMEs may be required in certain situations, and independent medical examiners must meet the criteria of being qualified and appropriate for the specific assessment.

Can a workers compensation claim be reopened?

Yes, a workers compensation claim can be reopened, here are some of the reasons as to why a claim can be reopened:

  • Recurrence of an existing work injury
  • Further payment is required via weekly payments or medical expenses
  • To fix any data errors related to your claim
  • Disputing a provisional liability decision

To get more information on this, make sure you read our article – Can I reopen a workers compensation claim?

How can workers compensation help you?

Workers compensation provides crucial support to individuals who have been injured or become ill due to work-related activities. It offers financial assistance for medical expenses, rehabilitation costs, and lost earnings during recovery periods.

Additionally, workers compensation can provide lump-sum payments for permanent impairments, periodic payments for dependents, and access to various support services such as education and training, medical specialists, rehabilitation providers, and domestic assistance.

File a workers compensation Claim with Alliance Compensation & Litigation Lawyers today

We understand that being injured at work is a stressful and overwhelming period. With Alliance Compensation & Litigation Lawyers, we’ll guide you through every step of the way whilst ensuring that you understand what you are entitled to. Your compensation is our reputation.

Book your free no-obligation consultation with us to discuss your workers comp case at (02) 8764 1776 or email us at refer@alliancecomplawyers.com.au

We have offices in Canley Vale, Bankstown, Fairfield, and Strathfield, making it convenient to visit in person to discuss your case.

Frequently Asked Questions

Can you work after making a workers compensation claim?

Yes, it is possible to return to work after making a workers compensation claim in Sydney. The workers’ compensation scheme aims to facilitate the recovery and return to work of injured employees. It is important to find suitable work options within your capacity to ensure a safe and sustainable recovery. You can discuss your situation with an experienced workers compensation lawyer who can help you determine the best course of action. They can guide you on changing jobs without impacting your compensation claim and assist you in navigating the process.

Can I resign while on workers compensation in NSW?

Yes, you can resign while on workers compensation in NSW. However, there are implications to consider. If you resign while still receiving workers compensation benefits, your weekly payments may be reduced or suspended if you are deemed fit to work. It is advisable to obtain legal advice before making any decisions regarding resignation while on workers compensation. A workers compensation lawyer can guide you on your rights and entitlements during this period and provide valuable insights specific to your circumstances.

Can I get a new job while on workers compensation in NSW?

Yes, it is possible to get a new job while on workers compensation in NSW. The workers’ compensation scheme recognizes the importance of returning to work, whether it is with the same employer or a new one. You can discuss your options with a dedicated workers compensation lawyer who can help you understand the implications and ensure a positive outcome. They can guide you on changing jobs without affecting your compensation claim and provide tailored advice based on your specific situation.

Can you terminate an employee on workers compensation in NSW?

It is illegal for employers to terminate employees solely because they are unfit to resume regular duties within the first six months of their injury in NSW. Employers have obligations to assist injured workers in their recovery and facilitate their return to work. This may involve providing suitable duties or adjusted hours. 

However, termination can occur if the employer can demonstrate that they have taken all reasonable steps to assist the employee and that there is no suitable work available. If you believe you have been unfairly terminated while on workers compensation, it is advisable to seek legal representation to understand your rights and explore potential recourse.

Can you be made redundant while on workers compensation in NSW?

Yes, it is possible to be made redundant while on workers compensation in NSW. Redundancy occurs when an employer no longer requires a particular job to be performed. However, there are rules and regulations in place to protect employees on workers compensation. Employers must follow specific criteria when making an employee redundant, such as providing notice and considering redeployment options. While on workers compensation, you may continue to receive compensation benefits. If you believe you have been unfairly made redundant while on workers compensation, it is advisable to seek legal advice to understand your rights and entitlements.

Can I claim workers compensation if I’m a casual employee?

Casual employees are entitled to workers compensation benefits if they’ve been injured in the workplace in NSW. Read our article “Casual Employees & Workers Compensation: Are you covered?” to learn more about your rights as a casual employee.

Get in touch to find out more HERE … or call 02 8764 1776
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