Workers compensation payments in New South Wales: weekly payments, medical expenses and lump sums

A New South Wales workers compensation claim can lead to different types of benefits including but not limited to weekly payments, medical or related expenses and lump sum payments. Each has its own rules, and being paid one does not automatically mean you are entitled to the others.

This article explains what each payment is for, in general terms. It does not promise any amount, because what you receive depends on your circumstances.

How the claim connects to the payments

Payments only start flowing once a claim has been lodged and the claim is accepted by the workers compensation insurer. Generally, your employer’s insurer manages the claim in accordance with the Workers Compensation Act 1987 and the Workplace Injury Management and Workers Compensation Act 1998. The scheme is regulated by the State Insurance Regulatory Authority, known as SIRA.

Our guide to making a workers compensation claim in New South Wales sets out the steps, from advising your employer to the insurer’s decision. This article picks up from there and looks at what the payments are once a claim is accepted.

Weekly payments

Weekly payments are designed to replace part of the income you lose if you cannot return to your pre injury duties as a result of the work related injury. They are not full wages. The amount is worked out from your pre injury average weekly earnings and from what your doctor says you are able to do, and the amount changes as time passes and as your capacity changes.

The key medical document is the certificate of capacity completed by your nominated treating doctor. It records whether you can work, what duties are suitable, and for how long. If you return to some types of work, your weekly payments will be adjusted to reflect what you earn.

You require a certificate of capacity that is current to continue receiving weekly payments so have your certificate updated by your treating doctor. The scheme places limits on how long weekly payments may continue, and those limits depend on your circumstances. Strict timeframes apply, so ask about your entitlements early rather than late.

Medical or related expenses

The insurer may pay for reasonable and necessary medical, hospital and rehabilitation expenses in relation to your work related injury. This can include treatment by medical practitioners, physiotherapists, chiropractors, osteopaths, psychologists, counsellors, exercise physiologists, and other allied health practitioners.

In some circumstances provision of artificial aids, domestic assistance services, nursing, medical and medicine supplies and modifications to your home or vehicle may be included as well as hospital treatment, ambulance services, workplace rehabilitation services and travel expenses to attend medical appointments.

The insurer will only pay for treatment or services which are reasonable and necessary as a result of your work related injury, and they may ask for evidence of why your doctor recommends such treatment. Pre approval should be sought for most treatment. If the insurer declines treatment, that decision may be reviewed. Keep receipts and any written request for treatment as they may be required when a decision is being reviewed.

Lump sum payments

Permanent impairment

If your injury leaves you with a permanent impairment, you may be able to claim a lump sum compensation. This is a payment for the lasting effect of the injury on your body, not for lost wages, so it is separate from weekly payments.

The lump sum depends on an assessment of the degree of impairment by a medical specialist. A minimum percentage of impairment is generally required for a claim for lump sum compensation, and the assessment cannot usually be done until your condition has stabilised.

Our article on whole person impairment explains how the percentage is generally worked out and why two doctors can see a case differently.

Work injury damages

Work injury damages claim is a separate claim against your employer for negligence, seeking compensation for past loss of earnings and future loss of earning capacity.

This option is available only in limited circumstances. It generally requires a higher level of permanent impairment than the lump sum does, and it has its own procedures and strict timeframes. The facts of how the injury happened also matter. Because the rules are technical, it is the payment type where early legal advice should be sought.

Commutation

In some circumstances a lump sum payment to settle certain ongoing workers compensation entitlements is available by way of an agreement between you and the insurer and independent legal advice must be obtained before entering into an agreement and must also be approved by the Personal Injury Commission. There are strict eligibility requirements so you should seek early legal advice.

Money questions outside the claim

Receiving compensation especially a lump sum payment can raise questions about tax and future financial planning. Your position depends on your circumstances and you should seek advice from an accountant or a financial adviser. We give legal advice, not tax or financial advice.

What to do next

Keep a record of all documents in relation to your injury and documents from the insurer.

If you are not sure what payments you are entitled to, if weekly payments have been reduced or stopped, if a treatment has been denied or if you want to know whether a lump sum payment is available to you, act promptly because strict timeframes may apply. Our guide to time limits for personal injury claims explains how these limits generally work. You can check your entitlement or contact our Sydney office to talk it through.