Published: 13 April 2018
Author: Michael Burdess
Common WorkCover enquiries
I've received a letter from my insurer saying that my payments will stop because I have had 130 weeks of payments, what do I do?
For people that are on weekly payments for significant periods of time, it is likely that once they get near the 130-week mark (two and a half years) that they will receive a letter from the insurer saying that their payments will stop at 130 weeks.
The reason for this is that the law in Victoria states that for the majority of people, their payments will stop at this point.
What would someone have to show to prove they should receive payments beyond 130 weeks?
There are two steps to this test, the first being does the worker have “no current work capacity”? Put another way, do you have capacity for any suitable employment? The term ‘suitable’ means any employment which you might be suited to do considering your age, work history, education and so on), not just the job that you used to do.
The second part of the test is whether that incapacity for all work is likely to continue indefinitely. Indefinitely does not mean forever but does mean at least long-term.
For the majority of people it is quite difficult to establish both parts of the test. Some people may be able to establish that they have no current work capacity but it may only be a temporary incapacity. Others may have a permanent incapacity but not be able to satisfy the first part of the test, for example, they might be able to work 20 hours a week where they used to be able to work 40 hours.
If the insurer decides to terminate your payments at 130 weeks then that decision may be challenged. Refer to our previous blog re disputing a WorkCover decision.
Consequences related to terminated WorkCover payments
It is not often that someone will successfully challenge and overturn a 130 week termination prior to their weekly payments actually stopping.
This puts the worker in a very difficult position in terms of income. There are a number of options open to workers in this position. Firstly, they should check any superannuation policies they hold to see whether there may be income protection insurance available to them through their super. This may be something that will cover a wage to a similar degree as the previous WorkCover payments.
If you do not have any income protection insurance then you should also consider going to Centrelink, ensuring that you take a copy of the letter from the insurer terminating your payments, so that Centrelink can see when your entitlement to payments finishes.