Benefits for workers

Benefit reforms for injured workers were made law in August 2015. The benefit reforms focus on three objectives: helping injured workers with the highest needs, assisting those with injuries to return to work, and applying benefits equitably for all injured workers.

The following benefits took effect on 16 October 2015:

  • increased maximum lump sum compensation for permanent impairment up to $577,050
  • increased death benefit lump sum amount up to $750,000
  • increased maximum for funeral expenses up to $15,000
  • weekly payments extended for 12 months beyond retiring age.

The following benefits took effect on 4 December 2015:

  • medical benefit cap extended for all claims
  • lifetime compensation for artificial aids, home and vehicle modifications for all approved claims
  • lifetime medical expenses for injured workers with high needs
  • minimum weekly compensation payments for injured workers with highest needs
  • minimum work hours removed for injured workers with high needs
  • secondary surgery now available for all eligible workers
  • suspension of a work capacity decision pending the result of a review.

The following benefits took effect on 29 April 2016:

  • new employment assistance (of up to $1,000) for eligible workers who are unable to return to work with their pre-injury employer and need assistance in starting with a new employer
  • education or training assistance (of up to $8,000) for eligible workers who require additional skills to improve readiness for work with their current employer or a new employer.

The regulatory framework for legal costs for work capacity decision reviews is in development. More information will be available soon.

Consultation on the regulation of pre-injury average weekly earnings (PIAWE) is complete, and the submissions received are now being considered. More information will be available soon.

Click on the benefit icons below for more information on the benefits and how they will affect you. There are also questions and answers for more information.

Medical benefit cap extended

The compensation entitlement period for medical treatment has been extended for all claims.

From 4 December 2015 all workers are entitled to at least two years of medical benefits from when weekly payments stop being payable or from the date of claim if no weekly payments are made, whichever is later.

Further time frames are: five years for those with 11-20 per cent permanent impairment or for life for those with greater than 20 per cent permanent impairment.

Before the reforms, claims for those with less than 30 per cent permanent impairment were limited to one year from the date the claim was first made or from the date the worker’s weekly payments stopped being payable. This reform provides additional time and support for all workers to recover and stabilise their medical conditions.

If you made a claim for workers compensation before 4 December 2015 you may be entitled to additional medical benefits or reimbursement. Contact your insurer to learn more.

What happens next?

Insurers will work to identify all claims affected by this reform and contact workers if their entitlements have changed.

If you think you are affected by the change, you can contact your insurer directly.

Artificial aids, home and vehicle modifications for life

Workers who require artificial aids, home and/or vehicle modifications are now entitled to lifetime access to compensation for these medical expenses.

From 4 December 2015, all workers have access to artificial aids such as prosthetics, crutches, eyes or teeth, hearing aids and batteries, other artificial aids, home and vehicle modifications for life.

Previously, workers with less than 31% permanent impairment had a 12-month cap on compensation for artificial aids from the date the claim was first made or from the date weekly payments stopped being payable, whichever was later.

This reform means that aids and modifications extend to all workers who need them, for life. There are around 18,000 people with existing claims that could benefit from this and new claims will be made every year.

If you made a claim for workers compensation before 4 December 2015 you may be entitled to additional medical benefits or reimbursement. Contact your insurer to learn more.

Scenario

Peter, a 45-year old boilermaker, made a claim for compensation for hearing loss six years ago. He was assessed and the insurer paid for the hearing aid. He had no time off work and did not receive weekly payments. Six years later, Peter’s hearing aid is not working well, making it hard for him to hear at work.

Previously, Peter was only entitled to a replacement hearing aid for 12-months from the date of his injury (as he had no time off and didn’t receive any weekly payments). He would have had to pay for the replacement hearing aid himself.

Now Peter is now able to claim a replacement hearing aid every five years, for life.

What happens next?

Insurers will work to identify all claims affected by this reform and contact workers if their entitlements have changed.

If you think you are affected by this change, please contact your insurer directly.

Lifetime medical expenses for workers with high needs

Workers with high needs (permanent impairment greater than 20 per cent) are now eligible to claim compensation for reasonably necessary medical treatment and services for life.

Previously, high needs claims were limited to one year from the date the worker’s claim was first made or from the date their weekly payments stopped being payable, whichever was later and lifetime medical expenses were reserved for workers with highest needs (permanent impairment of 30 per cent or more).

Now, the medical expenses safety net has been broadened to include those with more than 20 per cent permanent impairment, and extended for life.

If you made a claim for workers compensation before 4 December 2015 you may be entitled to additional medical benefits or reimbursement. Contact your insurer to learn more.

Scenario

Poh, a 50-year-old enrolled nurse, was injured at work a few years ago when she fell while lifting a patient. She sustained compression fractures to her lumbar spine. While off work, Poh completed Certificate IV in Leisure and Health.

A year ago, she returned to her pre-injury employer in a new role as a diversional therapist. So she can work the same hours as before her injury, Poh requires ongoing pain relief medication and occasional physiotherapy treatment for flare-ups. Her physiotherapist also monitors and upgrades her independent exercise program.

Previously, Poh would not have been entitled to medical and related expenses as more than 12 months have passed since her weekly payments stopped being payable. This means she would have had to pay for her own medication and physiotherapy. Now Poh has ongoing access to medical expense compensation for life.

What happens next?

Insurers will work to identify all claims affected by this reform and contact workers if their entitlements have changed.

If you think you are affected by this change, please contact your insurer directly.

New employment assistance

Benefit From when? Scenario
New employment assistance provides up to $1,000 to help injured workers who have secured work with a new employer, for expenses such as tools, work clothes, transport and child care.This is for any injured worker who returns to work with a new employer. This benefit commenced on 29 April 2016. Emma, a 37 year old process worker, injured her right knee at work. She was treated for her injury and attempted to return to her pre-injury employer, but was not able to. Emma had a vocational assessment and set a goal to seek work as a call centre operator. Emma was off work for 16 weeks and was receiving 80% of her pre-injury average weekly earnings. She couldn’t afford new clothes to start her new job. Under the benefit reforms, Emma and others like her who have an offer of employment, can apply for return to work assistance to pay for items that will assist them to take up their new position.

Eligibility

Workers are able to access new employment assistance where:

  • they are unable to return to work with their pre-injury employer because of their injury
  • they accept an offer of employment with a new employer
  • the offer of employment has been made in writing
  • the offer of employment is for a period of three months or more, and
  • the new employment assistance is provided to assist the worker to return to work.

Education or training assistance

Benefit From when? Scenario
Up to $8,000 for education and training assistance for workers assessed with greater than 20% permanent impairment who have been receiving weekly payments for 78 weeks (paid or payable) or more. This benefit commenced on 29 April 2016. Sharon, a 25 year old stable hand, had multiple fractures (lower limbs, pelvis and collarbone) from a fall from a horse. In the two years that passed, she had a range of treatment and interventions, some of which were not successful. Sharon’s condition deteriorated and her doctor certified she was not able to return to her pre-injury employer. Under the benefit reforms, Sharon can apply for up to $8,000 of education and retraining assistance which will assist her in gaining a diploma in office administration to re-join the workforce as an administration assistant in a veterinary practice. The payment would be made to the registered training organisation.

Eligibility

Workers are able to access education or training assistance where:

  • the worker has been assessed as having a permanent impairment of more than 20%
  • weekly payments have been paid or payable to the workers for more than 78 weeks
  • the education or training is provided to assist the worker to return to work
  • the education or training is consistent with the worker’s injury management plan; and
  • the training is provided by either:
    • a NVR-registered training organisation within the meaning of the National Vocational Education and Training Regulator Act 2011 of the Commonwealth
    • a registered higher education provider within the meaning of the Tertiary Education Quality Standards Agency Act 2011 of the Commonwealth.

Minimum weekly payment for injured workers with highest needs

There is now a minimum weekly compensation payment for workers with highest needs.

From 4 December 2015, workers with highest needs, that is, with permanent impairment of more than 30 per cent, are entitled to receive a minimum gross weekly compensation payment of $788.32. This amount will include any earnings the worker is being paid for, where appropriate. Where the worker’s weekly compensation payments are greater than the minimum amount of $788.32, then the higher amount is paid.

Previously, weekly payments did not include a minimum ‘safety net’ figure to help low-income workers with highest needs.

Now, the minimum weekly payment (indexed twice a year) will provide necessary financial support to workers with highest needs whose earning capacity is likely to be permanently affected as a result of their injury.

The benefit reform applies to all weekly compensation payments made on or after 17 September 2012. This benefit can be applied retrospectively from the date that a worker first meets the definition of a highest needs worker or 17 September 2012, whichever is the latter.

If you made a claim for workers compensation between 17 September 2012 and 4 December 2015 you may be entitled to a weekly payment top-up and/or retrospective payment. Contact your insurer to learn more.

Scenario

While working as a casual sales rep visiting clients, Anna had a serious injury in a car accident, just over 12 months ago. Anna currently has no capacity to work and has recently been assessed as having greater than 30 per cent permanent impairment. Anna’s pre-injury average weekly earnings were $500 a week.

Previously, Anna’s weekly payments would have been based on her pre-injury average weekly earnings of $500 a week. For the first 13 weeks Anna would have received 95 per cent of $500, which is $475 a week. From 14 weeks onwards, Anna would have received 80 per cent, which is $400 a week and continued to receive this amount as long as was required.

Now Anna’s weekly payments will be adjusted up to $788.32 gross per week from the date Anna met the definition of a highest needs worker.

What happens next?

Insurers will work to identify all workers affected by this reform and contact them if their entitlements have changed.

If you think you are affected by this change, please contact your insurer directly.

Minimum hours removed for workers with high needs

Minimum working hours and earning requirements for workers with high needs have now been removed.

From 4 December 2015, workers with high needs (permanent impairment greater than 20 per cent) are no longer required to work a minimum of 15 hours and earn a minimum amount (currently $176.00) in order to receive weekly payments after 130 weeks. This means workers with high needs who have been assessed by their insurer as having current work capacity will continue to have access to weekly payments after 130 weeks whether they have returned to work or not.

Previously, workers with more than 20 per cent impairment and current work capacity were required to work a minimum of 15 hours a week and earn a minimum of $176.00, in order to receive weekly compensation payments after 130 weeks.

This change allows workers with high needs with current work capacity (but not as much as 15 hours) to continue to build their capacity without losing access to weekly payments. It also means that workers with some capacity for work (but not as much as 15 hours) and unlikely to have any more work capacity, are not disadvantaged.

If you have made a claim for workers compensation before 4 December 2015 you may be entitled to retrospective and ongoing benefits. Some workers with high needs who have had their weekly payments stopped as a result of not working the minimum hours or earning the minimum amount, may have a retrospective entitlement to weekly payments. Contact your insurer to learn more.

What happens next?

Insurers will work to identify all workers affected by this reform and contact them if their entitlements have changed.

If you think you are affected by this change, please contact your insurer directly.

Increased amount of lump sum compensation

Benefit From when? Scenario
Increased amount of lump sum compensation for those with permanent impairment of more than 10% (15% or greater for psychological injuries). This benefit commenced from 16 October 2015 and applies to workplace injuries on or after 5 August 2015 that resulted in permanent impairment that meet the minimum thresholds. John is a 60 year old construction worker. He had a fall at work. After a number of operations, pain management treatment and home modifications, John had reached maximum medical improvement and has lodged a claim for permanent impairment. He was assessed as 31% permanent impairment and is considered a high needs injured worker. Previously, his lump sum benefit would have been $60,500. Under the benefit reforms, this will be $83,040 – a 38% increase.

Increase in death benefit lump sum amount

Benefit From when? Scenario
Increase in death benefit lump sum amount from $528,400 to up to $750,000, indexed twice a year. This benefit is for the dependents of deceased workers, or if no dependents, the worker’s legal representative. This benefit commenced from 16 October 2015 and applies to claims for compensation for a workplace fatality that occurred on or after 5 August 2015. Jim was working as an electrician when he had a fatal accident at work.  Jim had a wife and two young children at school who were all dependent on his income. Previously, the lump sum death benefit payable to Jim’s family would have been $528,400.Under the benefit reforms, the lump sum death benefit payable has increased to $750,000. This is a 41% increase.

Increase maximum for funeral expenses

Benefit From when? Scenario
Increased maximum for funeral expenses from $9,000 to $15,000, for families or friends of deceased workers. Increase is in line with current market costs.
This benefit commenced from 16 October 2015 and applies to claims for compensation where the date of the workplace fatality was on or after 5 August 2015. Jim was working as an electrician when he had a fatal accident at work.  Jim had a wife and two young children at school who were all dependent on the income from his employment. The maximum amount for funeral expenses had not changed since November 2004 although the cost of funerals had increased. Jim’s funeral costs were $12,000. Previously, his wife would have received $9,000 back.Under the benefit reforms, Jim’s wife will be fully reimbursed for the funeral costs. The maximum amount payable for funeral expenses is up to $15,000, which represents an increase of 67%.

Weekly payments and retiring age

Benefit From when? Scenario
A worker is entitled to up to 12 months of weekly payments of compensation after reaching retiring age. This benefit now applies to all eligible workers, regardless of when they were injured. This benefit commenced from 16 October 2015 and applies to claims for compensation that occurred after 1 October 2012.Note: This benefit was already available to those who made a claim before 1 October 2012. Ken is a 64 year old real estate agent. He injured his knee while at work and currently has no capacity for work while he undergoes treatment. Ken turns 65 in 3 months, which is his retiring age. Previously, Ken’s weekly payments would have stopped when he reached retiring age. Under the benefit reforms, Ken is now entitled to the three months up to retiring age and up to 12 months of weekly benefits post retiring age.

Claim for secondary surgery

Secondary surgery is now available for all eligible workers.

From 4 December 2015, all injured workers who require secondary surgery may be entitled to medical compensation for the surgery itself, as well as any post-surgery treatment such as medication or physiotherapy.

In order to be eligible for this benefit the secondary surgery must:

  • be directly consequential to an earlier surgery, and
  • affect a body part affected by the earlier surgery, and
  • be approved by the insurer within two years of the earlier surgery being approved (or later if the claim is disputed).

Previously, surgery benefits were limited to 12 months following the end of weekly payments. Now, the approval timeframe for secondary surgery has been extended, allowing injured workers and their doctors more time to schedule follow-up surgery without risk of out-of-pocket expense.

If you made a claim for workers compensation before 4 December 2015 you may be entitled to additional medical benefits or reimbursement. Contact your insurer to find out more.

Scenario

Adam is a 36 year old council worker who received significant burns to his forearm and part of his hand as a result of exposure to chemicals. Adam had initial surgery and returned to work for the council in an office-based role. His entitlement to weekly payments ended a few years ago and he is now no longer entitled to medical payments. As a consequence of the earlier surgery, Adam now requires two future skin grafts to optimise his hand function.

Previously, Adam would have to pay for these medical expenses himself. Now, so long as the secondary surgery is approved within two years of the earlier surgery being approved, Adam will be able to have the operations and the post-surgery treatment funded by the insurer.

What happens next?

Insurers will work to identify all claims affected by this reform and contact workers if their entitlements have changed.

If you think you are affected by this change, you can contact your insurer directly.

Suspension of a work capacity decision

No action can be taken by an insurer while a review of a work capacity decision is underway, provided the worker has applied for a review within 30 days from receiving the decision.

From 4 December 2015, insurers are not permitted to take action on a claim (like reduce or discontinue weekly payments) while a review of a work capacity decision is taking place.

Now, if a worker requests a review of a work capacity decision, all action is temporarily put on hold until the review of the decision has been completed.

If you made a claim for workers compensation before 4 December 2015 and your weekly payments were reduced or discontinued while a work capacity decision review was underway, you may be entitled to retrospective reimbursement. Contact your insurer to learn more.

What happens next?

Insurers will work to identify all workers affected by this reform and contact them if their entitlements have changed.

If you think you are affected by this change, you can contact your insurer directly.

Legal costs for a review of a work capacity decision

Legal practitioners are currently unable to charge injured workers or insurers in connection with a review of a work capacity decision. The new legislation allows for the payment of legal costs for legal advice on a review of work capacity decision subject to a regulation being made. The details will be defined in a new regulation. This reform will commence once the regulation is ‘made’, that is formally approved and published by the Government. The State Insurance Regulatory Authority (SIRA) has sought feedback on this regulation. For more information, visit http://www.workcover.nsw.gov.au/about-us/have-your-say/regulation-of-legal-costs-for-work-capacity-decision-reviews

Pre-injury average weekly earnings (PIAWE)

Generally, PIAWE is an average of ordinary weekly earnings over the 52-week period prior to an injury occurring. Any overtime and shift allowance payment may be included in the calculation of PIAWE for the first 52 weeks for which payments are payable.

Consultation with stakeholders during the early stages of the benefits reform showed support for a simpler approach to calculating PIAWE. Key areas of concern that have been raised with the existing approach to calculating PIAWE include:

  • the definition of PIAWE is complex
  • PIAWE can be difficult to determine
  • PIAWE is prone to different interpretations, increasing the risk of miscalculation.

The 2015 reforms include a provision to vary the method by which pre-injury average weekly earnings (PIAWE) are calculated. The reforms also allow regulations to be made to identify what constitutes a ‘non-pecuniary benefit’ and a ‘base rate of pay exclusion’, as these also form part of the calculation of PIAWE.

In early 2016, the State Insurance Regulatory Authority (SIRA) sought feedback from stakeholders on how a proposed new PIAWE regulation may operate. For more information, visit http://www.workcover.nsw.gov.au/about-us/have-your-say/regulation-of-pre-injury-average-weekly-earnings-piawe