Your claim, medical expenses and income

WorkCover covers all injuries which occur at work, or on the way to and from work if it’s an authorised recess like a lunch break. It’s your first call for immediate medical bills expenses and income support.

There is paperwork to fill in and a medical or doctor’s certificate is required. It is important to fill in the forms correctly because how you describe your injury may prejudice your claim to entitlements at a later stage, should your injury not resolve satisfactorily, or you develop complications. So, it’s advisable to have a WorkCover lawyer check your claim form.

Weekly benefits – income support

If your WorkCover claim is accepted, you will be offered a weekly income payment in replacement of your usual wage. Weekly payments are based on your average weekly earnings prior to the injury. The amount is calculated as a percentage (%) of your average weekly gross pay including your regular overtime and shift allowance – for the first 12 months, including employment with other employers.

Your first 13 weeks off work: 95% of your pre-injury wage. After 13 weeks off work: 80% of your wage for up to 130 weeks, or longer if you continue to remain unfit for work.

Note: allowances and overtime are payable for up to 52 weeks.

The maximum rate for weekly payment is twice the State average weekly earnings, currently standing at $2,000.

If you are covered by an employment agreement such as an EBA or Award, you may also be awarded accident make-up pay depending on the terms of the Agreement or Award.

Lump sum impairment

WorkCover may also pay you a lump sum for impairment, but this takes a little longer to obtain. This is a payment which WorkCover calculates on the basis of the severity of any permanent impairment injury you may have suffered. At this stage, you really should see a WorkCover injury lawyer.

Common Law compensation claims

Finally, you may also be entitled to pursue a common law claim if you have a serious injury and your injury occurred due to someone else’s negligence. A serious injury is one where you suffer an economic loss either completely or to the extent that you can only work to 60 percent of your pre-injury earnings or if you satisfy WorkCover or a Court that you have pain and suffering consequences that meet the test. Common Law claims are pursued through the courts.

Medical Expenses claims

WorkCover will pay what it considers to be “reasonable” medical expenses. This includes:

 
• doctors’ visits and medication

 

• hospital

 

• nursing

 

• rehabilitation, and

 

• ambulance expenses.

They will also pay for less obvious but equally helpful services such as home help or basic gardening services, should your injury prevent you from doing these things. Physiotherapy and chiropractor bills are covered, as are appointments to see your specialist, and surgery (if approved by the insurer). Mobility devices and special equipment, home and car modifications and transportation costs are covered if approved. For most people, medical expenses will be paid on an ongoing basis for a long period of time. If the insurer refuses to pay for a particular medical expense, you can contest that decision if there is support for the position that you require that expense.