IWSN Workers Compensation Handbook 2015...2015 Workers Compensation Handbook Oct 2015 Weekly Income...

2015 Workers Compensation Handbook Oct 2015

Chapter4

AvailableBenefits

There are several types of entitlements available tosomeoneonWorkersCompensationtheseinclude:

Weeklyincomereplacements

MedicalExpenses

RehabilitationSupport

TravelExpenses

PermanentImpairmentBenefits

PropertyDamageReimbursement

*With the 2015 changes the entitlements have increased. These are expected tocome into force in December2015.Theupdatedchangesareat thebackof thischapter.

The Injured Workers Support Network www.injuredworkerssupport.org.au Page �20

http://www.injuredworkerssupport.org.au


WeeklyIncomeCompensation


0–13weeks 95%ofpreinjuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings. CorrectasofApril2015.changingDec2015

14weeks–2.5years

Iftheinjuredworker’sworking15ormorehoursperweek Iftheinjuredworker’snotworking15ormore

hoursperweek

Thelesserof95%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings

Thelesserof80%ofpre-injuryearningsor$1999.30.-MinuscurrentorpotenOalweeklyearnings

2.5–5years.Theinjuredworkerneedtoapplyforongoingweeklyincomereplacements.

Iftheinjuredworkerhavenoworkcapacityindefinitely,orIftheinjuredworker’sworking15+hoursandearning$173+perweek,andareunabletoincreasehowmuchtheinjuredworkerwork/earnindefinitely

Iftheinjuredworkerhavesomeworkcapacitybutarenotworking15+hoursandearning$173+perweek,orIftheinjuredworkercouldincreasehowmuchtheinjuredworkerwork/earn


Theinjuredworkersweeklyincomereplacementscease

5+years

Iftheinjuredworkerare‘aworkerwithhighestneeds’,orIftheinjuredworkerhave21–30%permanentimpairmentandeither:Havenoworkcapacity,orAreworking15+hoursandearning$173+perweek

Iftheinjuredworkerhave20%orlesspermanentimpairment,orIftheinjuredworkerhave21–30%permanentimpairmentandsomeworkcapacitybutarenotworking15+hoursandearning$173+perweek




TheInjuredWorkersentitlementsaredependenton:

Theperiod forwhich theyhavebeen receivingweekly incomereplacements

Theircapacityforworkasassessedbytheinsurer

Theinjuredworkerscurrentworkstatusand

Theinjuredworkerstotalbodyimpairmentpercentage.

Weeklyincomereplacementsandretirement

Weeklyincomereplacementscontinueforoneyearoncetheinjuredworker reach the official commonwealth retirement age with thefollowingexceptions:

If they are injured at work after they have reached the retirementage,the injuredworkerwillreceiveweekly incomereplacementsfor12 months beyond the date of their claim (if liability has beenaccepted).

Weeklyincomereplacementstoinjuredworkerswhoreturntoworkonsuitableduties

If the injuredworker ispartially incapacitated followingaworkplaceinjury and return toworkon suitable duties the injuredworkerwillearnincomeforthehourstheyworkwhileundertakingthoseduties.If this income is less thanwhat they earned before the injury thenthey may also receive a weekly workers compensation incomereplacement,oftenreferredtoas‘make-up’pay.

Can weekly income replacements be stopped orreduced?

There are several ways the injured workers weekly incomereplacementsmaystop:

Theinsurerdeniestheinjuredworker’sclaimwhiletheinjuredworkerarereceivingincomereplacement.

Theinjuredworkerreturnstofulldutiesonthesamepay.

Theinjuredworkerareassessedasbeingabletoworkformorethan15hoursaweek(wethertheinjuredworkerhaveajobornot). Their weekly income replacements may be reduced tomatch what they insurer considers to be the injured workersearningcapacity.

Theinjuredworkerarenotaworkerwithhighestneedsbutarenot working and have reached the two and a half yearthreshold.

The injured worker are not a worker with highest needs, andhavereachedthe5yearthreshold.




Usingsickpayandannualleave

Aworker can use their sick leave or other leave entitlementswhilethey are waiting for entitlements to be paid. Depending on theirenterpriseagreementtheymaybeabletotopuptheircompensationif the rate drops. Check the employment award or enterpriseagreement.

Annualleaveandentitlements

While they are still working (on the books of their employer). Aninjured worker is entitled to receive, in addition to their WorkersCompensationentitlements:

Annualleave

Publicholidays

Longserviceleaveprorata,whileemployed

But:Theycan’tbepaidsickleaveandcompensationsimultaneously




MedicalorrelatedexpensesInjured workers are entitled to have all their reasonable medicalexpenses paid by the insurer up to 2 years* after the insurer hasstoppedtheinjuredworkersweeklyincomecompensation.

Treatment by medical practitioners, physiotherapists,chiropractors, osteopaths, psychologists, counsellors, exercisephysiologists,massagetherapists,otherhealthpractitioners

Domesticassistanceservices

Nursing, medical and medicine supplies (provided outside ofhospitaltreatment).

Most treatment requires prior approval, however some treatmentdoesnotrequirepriorapproval.Thesemayinclude:

Treatment provided within the first 48 hours following theinjury

Consultation with the nominated treating doctor (with theexceptionofmentalhealthconsultationsusingtreatmentitemsAA905andAA910)

The first consultation and treatment provided within thatconsultationwiththefirstspecialistmedicalpractitioner

Pharmacyitemsprescribedbythenominatedtreatingdoctororspecialistmedicalpractitionerinthefirst3weekspostinjury,toamaximumof$500andforpharmacyitemsexcludedfromthePharmaceuticalBenefitsSchemetoamaximumamountof$100

*fromDecember2015seenotesattheendofthischapter

All plain x rays performed on referral from the nominatedtreating doctor or specialistmedical practitioner in relation totheinjuryclaimedandprovidedwithinoneweekofinjury

Services provided in public hospital's that are provided by orconsequent upon presentation at the hospital's emergencydepartmentfortheinjuryclaimedthatarewithinonemonthofthedateofinjury

Some consultations for physiotherapy, osteopathy orchiropractictreatment

Somepsychologytreatmentorcounselling.

Itisadvisablethattheinjuredworkerandtheirdoctorformulateaninjurymanagementplancoveringmedicalinvestigation,treatmentrecoverand/oradaptationtotheinjuryasearlyaspossibleandprovidesthistotheinsurer.

Medicalentitlementstable*:

Permanent impairment percentage as of Dec 2015

10% 2 years from when weekly income replacements cease (or from date of claim if no weekly income replacements were made).

11-20% 5 years rom when weekly income replacements cease (or from date of claim if no weekly income replacements were made).

20% or more Medical entitlements are for life.




ArtificialAids,Home&VehicleModificationsLifelong access for all approved claims for access to artificial aidssuchasprostheticscrutcheseyesorteethhearingaidsandbatteries,other artificial aids, and home and vehicle modificationsIn (as ofDecember2015)

HospitaltreatmentHospitaltreatmentincludestreatmentatpublicandprivatehospitalsand/orrehabilitationcentres.

AmbulanceservicesAmbulance services include emergency, non-emergency and interhospitaltransfersprovidedbytheAmbulanceServiceofNSW.

SecondarySurgery:Is available for all injured workers who require secondary surgicalprocedure on the part of the body affected by the earlier surgery.Thismustbeapprovedbytheinsurerwithintwoyearsoftheearliersurgery(butdoesnotneedtooccurwithinthosetwoyears).inforceasofDec2015.

WorkplacerehabilitationservicesWorkplacerehabilitationservicesinclude:

Returntoworkandcasemanagement

Vocational,functionalandworkplaceassessments

Jobanalysisandmodification

Identificationofsuitableemployment

Workerretrainingandplacementinsuitableemployment.

Remember: the choice or rehab provider is theinjuredworkers.




TravelExpensesTo claim for payment for travel to attend medical, hospital andrehabilitationappointments,theinjuredworkerwillneedtokeep:

Arecordofthemileageiftheworkeruseshis/hercar

Receiptsforpublictransport.

Themaximumamountpayable forprivatecar travelassociatedwithattending medical, hospital and rehabilitation appointments isreviewedevery12months.

Forovernight tripsor trips involvingplaneor lengthy travel insurersshouldorganiseandpayfortheseinadvance.

PropertyDamageExpenses:

Damagetoartificialaids

If artificial eyes, false teeth, crutches, artificial limbs, other artificialaidsorspectaclesaredamagedinaworkrelatedaccident,aninjuredworkermaybeentitledtocompensation.

Thismayincludethe:

Reasonable cost of repair or, if necessary, replacement of theartificialaid

Service costs of qualified persons for consultations,prescriptionsandexaminationsinconnectionwiththerepairorreplacementoftheartificialaid

The loss of wages associated with attending consultations,prescriptionsandexaminationstorepairorreplacetheartificialaid.

Themaximumamountpayablefordamagetoartificialaidsis$2000.Thisamountcanbeincreasedonacase-by-casebasisbyWorkCover,orbyadirectionfromtheWorkersCompensationCommission.

DamagetoclothingIf an injured worker have a work related accident, they may beentitledtocompensationfortherepair,or ifnecessary,replacementofclothingdamagedintheaccident.

Themaximumamountpayable for damage to clothing is $600. Thisamountcanbeincreasedonacase-by-casebasisbyWorkCover,orbyadirectionfromtheWorkersCompensationCommission.




PermanentImpairmentBenefits:Ifaworkerhasapermanentimpairment(anacquireddisability)asaresultofaworkplaceinjuryorillness,theymaybeentitledtoreceiveapaymentundersection66oftheWorkersCompensationAct1987ifthey have suffered 10% if a physical disability or 15% if apsychologicaldisabilityormorepermanentimpairment.Theamounttheinjuredworkermayreceiveis:

IndicativeasofOctober2015.

SuingforNegligence(commonlaw):Beforeaninjuredworkercansuetheiremployerfornegligencetheymust meet a total body impairment of 11% for physical injury and15%forpsychologicalinjury.

Injured workers will need to employ a solicitor to run the case atcourt.

Initially,theWorkersCompensationCommissionattemptstomediateandreachsettlementthroughdiscussionswithandagreementofallparties.Ifanagreementisunabletobereached,workinjurydamagesclaimsareheardintheWorkersCompensationCommission.

If a work injury damages claim is not successful, the worker willcontinue to receive workers compensation under the statutoryscheme, butmay be liable for court costs incurred during theworkinjurydamages claim (this is rarebut consult a solicitor to knowalltherisks.

Ifaninjuredworkerthinkstheymaybeeligibletolodgeaworkinjurydamages claim and would like to proceed, they should first seekindependentlegaladvice.Iftheinjuredworkerareunsureofhowtolocateasuitable legal representative,An injuredworkercancontacttheir Union for legal representation of (if they aren't a unionmember)theWorkCoverIndependentReviewOffice.

Impa i rmen tpercentage

M i n i m u mpayment

M a x i m u mpayment

10%to30% $19,540 $78,340

31%to50% $83,040 $175,000

51%to55% $242,010

56%o60% $309,02061%to65% $376,03066%to70% $443,03070%to74% $510,04075%andabove $577,050




Commutation:A commutationpayment iswhere an insurer and an injuredworkeragreetoalumpsumpaymentratherthanongoingweeklypayments.Itcanonlyoccurif:

The injuredworkers total body impairment percentage is 15%orover

Two years have passed since the claim was accepted (with aminimumofsixmonthsofweeklyincomereplacements)anditwillbeongoing.

Allopportunitiesforinjurymanagementandreturntoworkfortheinjuredworkerhavebeenexhausted

Theinjuredworkerhasreceivedindependentlegaladviceaboutthecommutationoffer.

Commutation payments bundle up all future payments the insurermayoweaninjuredworkerintoasingle,oneoffpayment.

Notes:

Itisadvisablealwaystoconsultwiththeirunionlawyersbeforetakinganyactionagainstanemployeroraninsurancecompany.OnewillbeneededtoapproachtheWorkersCompensationCommission.

The WorkCover Independent Review Office will pay for legalrepresentationatthecommission.AlistofeligiblelawyersisavailableontheWIROwebsite.

DeathBenefits:In the unfortunate circumstance of a death of a worker there arethreeentitlementsavailable:

A lump sum payment of $750,000 to the dependents of thedeceased worker. (this applies to fatalities on or before 5August2015)

Reasonable funeral expenses of up to $15,000 (this applies tofatalitiesonorbefore5August2015)including

FuneralDirectorsfees,

costofthefuneralservice

Coffin

Mourningcar

Cemeterysite

Flowers

Newspapernotice,and

Deathcertificate.

Weeklycompensationof$135.30perdependentchild*

*Adependentchildisdefinedasachildorstepchildofaworkerwhowaswhollyorpartially dependent for support on them at the time of the workers death. Adependentchildmaybeentitledtoweeklysupportpaymentsuntiltheyreachtheageof16or,iftheyremainastudent,untiltheageof21.




October/December 2015Changes toBenefitsWeeklyIncomeCompensation:

IndicationasofDecember2015.


Injuredworkerswithhighestneeds(30%TBI) Minimumof$788.32perweek

0–13weeks 95%ofpreinjuryearningsor$1999.30-MinuscurrentorpotenSalweeklyearnings.

14weeks–2.5years

Iftheinjuredworker’sworking15ormorehoursperweek

Iftheinjuredworker’snotworking15ormorehoursperweek


Thelesserof80%ofpre-injuryearningsor$1999.30.-MinuscurrentorpotenOalweeklyearnings

2.5–5years.Theinjuredworkerneedtoapplyforongoingweeklyincomereplacements.

If:Theinjuredworkerhasatotalbodyimpairmentofover20%.Hasnoworkcapacityindefinitely,orIIftheinjuredworker’sworking15+hoursandearning$173+perweek,andareunabletoincreasehowmuchtheinjuredworkerwork/earnindefinitely.

If:Theinjuredworkerhasatotalbodyimpairmentofunder20%Hassomeworkcapacitybutarenotworking15+hoursandearning$173+perweek,orIftheinjuredworkercouldincreasehowmuchtheinjuredworkerwork/earn.

Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings Theinjuredworkersweeklyincomereplacementscease

5+years

Iftheinjuredworkerare‘highneedsorhigherneeds”(20%TBIorhigher)

Iftheinjuredworkerhave20%orlesspermanentimpairment,

Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings Theinjuredworkersweeklyincomereplacementscease

ReSrement AworkerisenStletoupto12monthsofweeklyincomereplacementsofcompensaSonaTerreachingreSrementage.


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