WorkCover (Victoria) in a Nutshell
You would have heard people refer to WorkCover and compensation payments but it seems there is a general misunderstanding about the whole process.
We often hear the following from our clients when making their initial enquiries:-
“I’m already getting my medical expenses and time off work covered so I’m under control”
“I’m back at work now and my case is closed”
“I don’t think my injury is serious enough to get compensation”
“My boss said not to make a claim and they will help me”
“The injury wasn’t really anyone’s fault so I don’t think I have a claim”
This article is our attempt to explain the WorkCover process in a nutshell so those with work injuries understand what’s involved and what may be available to them.
Step 1: Worker’s Injury Claim form
On average, just under 27,000 Victorians are injured at work, per year.
As soon as your work-related injury is diagnosed, you should complete a WorkCover claim form and provide it to your employer.
The form may be provided to you by your employer. Alternatively, it can be downloaded from the WorkCover website, or a hard copy form can be found at your post office.
It is important to lodge a claim to ensure that you are protected and can pursue a lump sum claim within 6 years of the injury.
Once your claim form has been submitted to your employer, WorkCover has 30 days in which to accept or reject your claim.
Before your claim is accepted, you may be contacted by an investigator seeking a statement from you as to what you say occurred.
You should obtain certificates of capacity from your treating doctor during this period and keep copies of all receipts for medical treatment paid for by you.
Step 2: Claim is accepted = Payment of medical expenses and weekly payments
Once your claim is accepted, you are entitled to receive payment of medical expenses deemed to be ‘reasonable’ and necessary for your injury and weekly payments of compensation calculated based on your pre-injury average weekly earnings (PIAWE). You will receive 95% of your PIAWE for the first 13 weeks and 80% of your PIAWE thereafter.
For as long as it is accepted you are incapacitated for work, you will be entitled to weekly payments of compensation. This will continue for up to 130 weeks from the date of your injury.
After this period, payments will only continue if you can prove you will not be able to work in any capacity, ever again.
Step 3: Impairment Benefits Claim (Between 1 to 6 years after your injury)
Despite whether or not you are able to make a return to the workforce, if you continue to suffer pain and/or restriction as a result of your injuries or condition, you may be entitled to a lump sum claim called an Impairment Benefit.
For physical injuries, in order to be eligible for compensation for the purpose of your claim, you need to be assessed as having 10% whole person impairment (WPI). If you are assessed as having 10% impairment or more, you are entitled to a lump sum of compensation, regardless of who may be at fault. This assessment will be carried out by a qualified practitioner familiar with the impairment assessment guidelines.
For psychological injuries in order to be eligible for an Impairment Benefit, you need to be assessed as having 30% impairment. Again, compensation will be payable regardless of fault.
This compensation is paid in addition to weekly payments and medical and like expenses.
Step 4: Serious Injury Application
This is the first step towards claiming a larger sum of compensation for pain and suffering damages and economic loss.
This is an application where you must establish a 30% impairment, total loss injury or demonstrate your injuries are serious enough for you to be compensated.
The granting of a serious injury certificate is just that, a certificate which recognises your injury is serious enough to be paid damages for your pain and suffering and/or economic loss.
You can make an application for pain and suffering damages only if you continue to have a capacity for work but have ongoing pain and restrictions.
You may be deemed to have a serious injury even if you were not assessed at the required threshold to receive an impairment benefit.
Step 5: Common Law claim
Once you have been granted a serious injury certificate, the next step is to determine the sum of damages payable to you. This is often referred to as a claim for common law damages.
If you are granted a serious injury certificate, discussions will ensue about what the injured person is worth, in an attempt to resolve the matter.
In order to calculate what someone is worth, regard must be had to the following: -
Whether you can establish negligence on the part of your employer
The severity of your injuries and impact on your life
Whether you are able to work at present or in the future
Whether you received a lump sum payment by way of Impairment Benefit.
Whether you have received weekly payments of compensation
Whether you had any pre-existing injuries or conditions
If a decision cannot be reached in relation to quantum, the matter will be referred to Court for a Judge or jury to decide the sum of damages payable.
If you cannot establish negligence on the part of your employer, it is unlikely you will be successful in obtaining compensation, even though you may have a serious injury.
If you have any questions in relation to the process or want to find out what you may be worth, please contact us and book a free assessment today.