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Your Guide to a Successful Workers Compensation Claim

Table of Contents

What is workers compensation?

Workers’ compensation is a form of insurance that provides benefits to injured workers’ who have suffered a workplace injury or have developed a medical condition in the course of, or as a result of, their employment.

What is workplace injury?

  1. Work-related injuries might include suffering an injury at work on a specific day or developing a medical condition over a period of time due to the nature of the work performed.
  2. Injuries can be physical or mental
  3. Diseases caused by your work
  4. Pre-existing conditions made worse by your work
  5.  However, dust diseases or injuries sustained whilst travelling to or from work are not workplace injuries

Workplace injury examples:

  • Spinal injuries
  • Back injuries
  • Slipped disc injuries
  • Arm injuries
  • Hand or finger injuries
  • Leg injuries
  • Foot or toe injuries
  • Head or eye injuries
  • Brain Injuries
  • Repetitive strain injuries
  • Construction injuries
  • Farming accidents
  • Industrial accidents
  • Death dependency
  • Cancer conditions
  • Heart attacks
  • Strokes
  • Severe stress
  • Fractures
  • Neck injuries
  • Soft tissue injuries
  • Chemical and asbestos exposure
  • Industrial asthma and other lung conditions
  • Industrial deafness
  • Infectious conditions
  • Psychological conditions.
  • Diseases caused by work
  • Diseases or pre-existing conditions made worse by work
  • Injuries suffered whilst travelling for work
  • Injuries suffered while receiving medical treatment for a separate work injury

What conditions must be satisfied for making a workers compensation claim?

1. The worker must be an employee. An employee can be:

  • a. A full-time worker
  • b. A part-time worker
  • c. A casual worker
  • d. Self-employed worker
  • e. A volunteer
  • f. A trainee, apprentice or work experience student

2. The worker must have a medical condition that has been diagnosed by a medical practitioner

3. This medical condition must have arisen due to the course of the worker’s employment, where the employment was a substantial cause of the condition

4. The worker has suffered a financial loss

What is covered in workers compensation payout?

The following table summarises the weekly workers compensation payments in NSW you may be eligible to claim for injuries that have occurred after 21 October 2019:

Entitlement PeriodEntitlement
Weeks 0-13Up to 95% of pre-accident earnings
Weeks 14-130 (no work capacity)Up to 80% of pre-accident earnings
Weeks 14-130 (some work capacity)Up to 80% of pre-accident earnings (payments increase to 95% if working 15 hours per week and earning at least $200 per week)
Weeks 131-260 (no work capacity)Up to 80% if no work capacity is likely to continue indefinitely
Weeks 131-260 (some work capacity)Weekly benefits stop for most, some exceptions apply
After 5 yearsWeekly payments only available to people with WPI (Whole Person Impairment) >20%

How long can you claim workers compensation?

You can generally claim workers compensation for up to 5 years. However, if your permanent impairment is greater than 20% and you have been assessed as being unable to work indefinitely, then this five-year limit no longer applies.

Generally, your weekly workers compensation payments will continue when:

  1. You’re able to return to work
  2. You reach a work injury damages settlement
  3. You’ve been receiving payments for five years (unless your permanent impairment is greater than 20% and you have been assessed as being unable to work indefinitely)
  4. You reach the maximum total weekly compensation limit
  5. You reach retirement age plus one year

Workers with greater than 20% permanent impairment may be entitled to weekly payments beyond this five-year cap, and are entitled to medical treatment, service or assistance for life.

What should you do if you had a workplace injury?

  1. Inform your employer immediately after you are injured at work
  2. Seek medical treatment with your doctor and request a certificate of capacity. You’ll need medical evidence to prove your injury is work related.
  3. Contact Jameson Law to obtain legal advice as soon as possible after you are injured as strict limits apply
  4. Complete a workers compensation claim form through:
    https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/forms/workers-and-claims/SIRA08684-Workers-injury-claim-form.pdf
  5. Submit your completed claim form to your employer and their insurer
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