There’s no doubt that injuries can be expensive. If you’ve suffered a work-related injury and the medical bills are piling up, what you really need is peace of mind that you won’t be left out of pocket. That’s why it’s helpful to know how much compensation you’re likely to receive if you’re considering making a workers compensation claim.
Entitlement to compensation
If you’ve been injured at work, you are entitled to be compensated for costs including:
- Medical services such as consultations with doctors including general practitioners, psychologists, physiotherapists and/or specialists.
- Hospitalisation and all associated medical, surgical and nursing services.
- Approved recovery or return to work services.
- Medication or other material purchased on the prescription or recommendation of your health practitioner.
- The provision, maintenance, replacement or repair of therapeutic appliances or prostheses.
- Accommodation expenses when spending time away from home to receive medical services (for example, due to living in a remote location).
- Travelling to and from any place to receive medical services, hospitalisation or approved recovery/return to work services.
Following your injury, your doctor may provide you with a Work Capacity Certificate or a Prescribed Medical Certificate. This is a medical certificate that may say that you have a physical or psychological incapacity to return to work. It may say that you can’t return to work at all for the time being, or that you can only work on a part-time basis with certain restrictions on your duties.
How much can I claim?
If your normal working hours are reduced, you are entitled to make a claim for weekly income maintenance payments (income support). If your injury occurred on or after 1 July 2015, you are entitled to a maximum of 2 years’ worth of weekly income maintenance payments (from the date of the injury).
For the first 52 weeks of that period, you will be entitled to weekly payments equal to your notional weekly earnings (also known as average weekly earnings). If you still have reduced capacity at the end of that first year, your entitlement to weekly payments will be reduced to 80 percent of your notional weekly earnings for the time that you are incapacitated during the remaining 52 weeks.
How are weekly payments calculated?
In essence, your earnings in the 52 weeks prior to the injury are used to find the average amount – the notional weekly earnings – that you have earned in that time. This can also include the value of other benefits such as mobile phones, cars and carparks. It can also include:
- Access to a discounted rate of interest on a loan.
- Payment of school fees.
- Payment of health insurance premiums.
- Payment of medical benefits.
- A computer for personal use.
- Access to the internet.
- Payment of, or towards, housing costs.
- A staff discount programme.
- A credit card.
This is a complicated area and legal advice is necessary to ensure that all of your entitlements are properly calculated and incorporated into your average weekly earnings rate.
Previous lump sum payments
If you had a previous work injury and entered into a redemption agreement that allowed you to receive a lump sum payment, your notional weekly earnings may be reduced. It will be necessary for you to have legal advice about this before making a decision about how to proceed.
What is a redemption agreement?
A redemption agreement is an agreement that an injured worker makes with the compensating authority to receive a lump sum payment in exchange for the worker giving up their entitlement to weekly payments and/or medical expenses. For further information, click through to our redemption payment page.
Whole Person Impairment
If you have been assessed as having whole person impairment (WPI), there are exceptions to the general rules about how much you can claim.
WPI means that you have suffered permanent physical impairment because of your work injury. The percentage of permanent impairment that you have suffered to your whole body will determine an additional entitlement to a lump sum payment as well as any income maintenance and medical expense entitlements.
If you are assessed as suffering from 30 percent or more WPI, you will be classified as a “seriously injured worker.” This means that you can continue to claim weekly payments at 80 percent of notional weekly earnings until you reach retirement age. You can also claim medical and other related expenses for this period.
If you have been assessed with a WPI of between 5 percent and 29 percent, you won’t be categorised as “seriously injured” but nevertheless in many cases you can claim medical expense entitlements for up to one year after the last day of your income maintenance payments.
WPI assessments must be carried out by an accredited permanent impairment assessor. A good workers compensation lawyer can provide you with further information.
If you were injured before the new workers compensation laws came into force on 1 July 2015, the old laws may still apply. You may still be entitled to a lump sum payment, but you should seek legal advice to work this out.
If you have been injured at work, you are entitled to be compensated for the cost of legal advice and representation. This entitlement arises only if your claim is genuine and the South Australian Employment Tribunal (SAET) will determine this.