Published: 23 October 2017
Author: Stringer Clark

WorkCover claims after the maximum benefit period

I have a workcover claim and have received weekly benefits for the maximum period, but now my doctors want me to have further surgery which means I’ll need more time off work. What income will I live on?

Under WorkCover, injured workers are entitled to a maximum of 130 weeks of weekly payments of compensation, unless they can prove that they have no capacity to work any job, and that this likely to be permanent or last for the foreseeable future.

If a worker, after this period expires, requires further surgical treatment and further time off work during their recovery, the WorkCover legislation makes allowances for this, provided:

1. You have returned to work (perhaps on suitable duties, possibly your usual duties for limited hours) for a period of not less than 15 hours per week; and
2. You receive current weekly pay of $177 per week gross (before tax); and
3. You have not received compensation in the form of weekly payments other than weekly payments for at least 13 weeks following the 130^th week you have received weekly payments of compensation; and
4. You require surgery for that injury, which the WorkCover insurer will pay for; and
5. You suffer an incapacity for your work because of the subsequent surgery; and
6. You have not attained retirement age (65 in many cases, but may be older depending on when your injury happened).

The rate of weekly payments are to be paid as at the rate you were receiving prior to payments were made to you during the ‘second entitlement period’; i.e. 80% of your pre-injury earnings, without regular overtime or allowances.

You would need to apply to your WorkCover insurer for these payments who then must, within 14 days of such application, approve or reject your application and give reasons why it has been rejected if that’s the case. There is technically no limit on these payments, but they are likely to be the subject of considerable scrutiny by WorkCover insurers to ensure they are not paying you more than is needed to recover from your work-related surgical procedure(s).