Everyone has the right to go to work each day, knowing they’ll come home safely. If you’ve been injured or become ill at work you may be entitled to make a claim for workers’ compensation to cover lost wages, medical and rehabilitation costs, retraining expenses or a lump sum payment for permanent injuries. This applies if your injury or illness is psychological in nature. 

There have been a lot of changes to arrangements in NSW for seeking workers’ compensation in recent years. You could be forgiven for being a little confused about where to start. After all, workers’ compensation laws and entitlements are already a little hard to keep up with because they vary between states and territories and may be known as WorkCover, CTP or WorkSafe. Compensation and benefits can vary greatly depending on your injury and on the law you’re covered by. 

If you’ve been injured at work in NSW, Littles has you covered. This blog sets out the process for making a workers’ compensation claim. 

Read more here: 

Your NSW workers’ compensation FAQs – Part 1 – Littles

Your NSW workers’ compensation FAQs – Part 2 – Littles

Before we kick off…

Many of the recent changes to workers’ compensation arrangements in NSW don’t’ apply to 

• police officers, paramedics and fire fighters

• coal miners 

• bush fire fighters and emergency service volunteers (including Rural Fire Service, Surf Life Savers, and SES volunteers), and 

• people with a dust disease claim under the Workers Compensation (Dust Diseases) Act 1942.

First things first – do you have a workplace injury?

To be eligible to claim workers’ compensation in NSW, you must have sustained an ‘injury arising out of or in the course of employment’. You will be able to claim compensation whether the injury occurred ‘at or away’ from your place of employment. This may include circumstances where you are injured travelling to or from work and home. 

This also includes any ‘disease injury’ which includes a:

• disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease; and

• the aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease; and

• does not include (except in the case of a worker employed in or about a mine) a dust disease, or the aggravation, acceleration, exacerbation or deterioration of a dust disease. 

What this means is that compensation will generally only be payable where there is a real and substantial connection between your  employment and the accident or incident which resulted in your injury.

If your matter ends up going through legal processes, the Personal Injury Commission or a court will consider all of the contemporaneous evidence available to determine if your injury was work related. If you’re unsure about this, or whether you are eligible to make a workers’ compensation claim, err on the side of caution – at minimum, report your workplace injury related medical condition to your general practitioner or medical specialist.

I’ve been injured in my workplace. What next?

If you have been injured at work, you should notify your employer of an injury as soon as possible after the injury or after diagnosis of any illness or disease. Your employer has an obligation to record any workplace injury or work-related disease in the register of injuries and notify their current insurer.  

Often, we know that reporting of injuries does not occur immediately, due to the nature and circumstances of the injury. However,  we strongly  recommend that claims for workers compensation are made within  six months of sustaining a workplace injury. 

If you do report an injury, you should also carefully consider seeking expert legal advice from  lawyer experienced in workers compensation at your  earliest opportunity. This will ensure you receive all benefits they are entitled to, including covering costs of your medical treatment and expenses. 

You’ll need a Certificate of Capacity from your treating doctor or specialist that specifies your capacity for work, the nature of your workplace injury, and the duration that you will be off work as a result.

How do I report my workplace injury?

Injured workers can now report their injury through a central system managed by ICARE:

• By phone: 13 77 22 

• By email: newpiclaims@icare.nsw.gov.au

Reporting workplace injuries through the central ICARE system will preserve an injured workers rights to workers compensation, as a claim number will be issued for future reference.

Did you know? Even where you think you only have a minor injury, it is still important to report it.  This is because an injured worker has a right to claim workers compensation for aggravations of the injury until their pension age, which in most cases spans between 65 and 67 years of age.  

How long does it take to make a decision on my claim?

The insurer generally has a maximum of two months  to decide if it will accept liability for your claim. It is common practice for workplace injury claims to be accepted on a ‘provisional liability’ basis. This means the claim is accepted for an initial period of 12 weeks and weekly payments will commence immediately. 

During the 12 week period, the insurer will investigate the claim prior to making a final determination.

Help! I can’t work but I still have bills coming in. What is my entitlement to weekly payments and medical expenses?

If the insurer accepts your claim, weekly benefits are paid in accordance with the formula of ‘Pre-Injury Average Weekly Earnings’ (PIAWE). PIAWE is generally paid at a rate of 95 percent of your ordinary weekly earnings, including overtime for the first 13 weeks and then at a reduced rate of 80 percent of your ordinary weekly earnings including overtime thereafter.

Did you know? The entitlement to weekly compensation is linked to your capacity to work in accordance with supporting medical evidence and any assessment of permanent impairment. There are situations which may allow you to claim an extended right to weekly entitlements and/or medical expenses beyond your entitlement period. Need more information? Contact Littles

Find out more about weekly entitlements here: Help! I’m an injured worker in NSW and my weekly payments have been ceased – Littles

What about the costs of medical treatment and related expenses?

Your entitlement to reimbursement for medical expenses is closely related to your entitlement to weekly compensation. The general rule that dictates whether medical treatment will be funded by an insurer is whether the treatment is ‘reasonable and necessary’. However, there are a number off exceptions to these rules. 

What if my workers compensation claim is rejected?

Don’t panic! If your claim is rejected, then the insurer is obliged to issue a ‘Section 78 notice’ together with all supporting evidence for rejected the claim.  These notices can be reviewed and/or disputed in the Personal Injury Commission. To review or dispute a workers compensation decision, you must generally have legal representation.

Find out more here: 

Do I need a lawyer to run my NSW workers’ compensation claim? – Littles

Help! My NSW workers’ compensation claim has been rejected. What do I do? – Littles

I’ve heard about ‘work injury damages’. What are they?

If you are injured at work in NSW, you can access the NSW statutory workers’ compensation scheme, which is administered by SIRA.  Under the statutory scheme, you may be entitled to payment for loss of wages, medical expenses and a permanent impairment lump sum payment. 

If your injury was a result of your employer’s negligence, you may also be eligible for compensation through a work injury damages or ‘modified common law’ claim. 

If you’re not sure whether your employer has been negligent under the law, it is important to  obtain high quality legal advice.

Been injured in NSW and wondering what ‘work injury damages’ are? – Littles

Don’t delay – seek advice now

Clearly, the workers’ compensation system can be complex, which is why it helps to seek quality legal advice as soon as possible. At Littles, we are experts in workplace injuries, and can help manage the process to ensure that you receive all appropriate entitlements and support. With Littles on your side, we can ensure that you get the fair treatment you deserve.  

If your workers’ compensation claim has been rejected, or you would like to understand how to claim benefits to support you and your family while you are injured or ill, please get in touch for a no-obligation chat. 

IMPORTANT: There are strict time limits for making and disputing a claim, so take advantage of our FREE initial consultation and get in touch. You have nothing to lose by speaking to one of our compensation law experts. The sooner we determine your eligibility to make or appeal a claim, the sooner we can help you to obtain or continue getting funding from the insurer so your rehabilitation can proceed smoothly. 

Free advice and no upfront fees

Not only do we offer a FREE initial consultation we handle most insurance claims on a no win, no fee basis.  

The Head of our NSW team, Jessica Cheung, is an expert in NSW workers’ compensation claims. If you think you might have a claim, reach out to Jessica and her team for high quality legal advice

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles. 

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles. 

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