Q&As for benefits commencing 16 October 2015

LUMP SUM COMPENSATION BENEFIT AND FUNERAL EXPENSES

Why are these benefits back-dated to 5 August 2015?

This was the date that the draft bill, the Workers Compensation Amendment Bill 2015, was introduced into Parliament. The Bill was passed on 13 August, but the Government decided to go with the earlier date.

RETIRING AGE AND WEEKLY BENEFITS

What has changed for workers injured at retiring age? And why?

Previously, depending on when a person was injured, weekly payments may have stopped at retiring age. All eligible workers are now entitled to up to 12 months of weekly payments of compensation after reaching retiring age. This benefit ensures equity for all workers approaching retiring age.

My weekly payments were stopped when I reached retiring age, what do I do now?

The insurer managing your claim will endeavour to identify all claims affected by the changes and contact you if you have an entitlement to weekly payments of compensation. You may also contact your insurer for information about the changes and how they may apply to you.

What evidence will I need to provide to my insurer to show I continued to be incapacitated as a result of my injury after reaching retiring age?

You will need to provide a certificate of capacity to your insurer which is completed by your nominated treating doctor. You will also need to complete the declaration that is attached to the certificate and send that to the insurer at the same time. Ordinarily a certificate of capacity cannot cover a period of more than 90 days before the date of the certificate. The NSW Government has changed the law to enable workers who have an entitlement because of this reform to have a certificate that covers a period of time of more than 90 days ago.

What happens if I am now on the aged pension?

Contact the insurer who managed your workers compensation claim to discuss the process required to claim your weekly payments of compensation.

If I have already started my aged pension who needs to contact Centrelink if my workers compensation weekly payments recommence?

Once it is agreed you have an entitlement, your insurer will contact Centrelink to advise them of your entitlement, including the gross amount per week you will receive and the period you will receive it for.

What happens to my other benefits attached to my aged pension if my weekly payments of compensation start again?

You will need to contact Centrelink to discuss what will happen to any other benefits related to your aged pension that you are receiving for the time you will receive weekly payments of compensation.

If my weekly payments were stopped almost three years ago do I get the weekly payments reinstated up to 1 October 2015?

No. You will only be entitled to weekly payment of compensation under your workers compensation claim for a maximum period of 12 months after you reached retiring age.

Will I be entitled to medical expenses?

You would have been entitled to reasonably necessary medical expenses for the 12 month period after your weekly payments previously ceased. You will also be entitled to payment for reasonably necessary medical expenses for the 12 month period after your reinstated weekly payments cease.

What happens if I have already paid my medical expenses? Will I able to be reimbursed?

You will be entitled to reimbursement for reasonably necessary medical expenses incurred during the 12 month period after weekly payments ceased. You will need to provide evidence that you incurred the expense as a result of your injury.

What happens if the insurer has not contacted me yet?

Your insurer will endeavour to review all claims where workers weekly payments of compensation ceased at retiring age and to contact those workers. This may take some time as case managers search their databases for workers who are eligible, determine what entitlements they should get under the new regulation, and contact each worker in this situation. Your patience during this time is appreciated, however, you may contact your insurer as your first point of contact for any enquiries.

What happens if I have a disagreement with the insurer about my entitlements?

Your insurer is your first point of contact for any enquiries. If you have raised your concern with the insurer and are still dissatisfied with the outcome or decision you may contact the State Insurance Regulatory Authority (SIRA) Customer Service Centre on 13 10 50. You can also contact the Workers Compensation Independent Review Office (WIRO) on 13 94 76. WIRO provides an independent complaints solution service. WIRO also provides funding for legal advice. For more information, call WIRO on 13 94 76.