NSW Workers’ Compensation Payout Guide

Getting sick or injured while working can take a serious toll on your mental and physical health, as well as your ability to bring in a salary to support you and your family. New South Wales (NSW) has strict work compensation laws that can ultimately ensure you have the money to pay necessary bills and expenses. In addition, you may be eligible to have your medical costs covered by workers’ compensation, depending on the circumstances.

Compensation for those injured while on the job

According to Fair Work Australia, workers compensation is “a form of insurance payment to employees if they are injured at work or become sick due to their work.” If you or someone you know has fallen ill as a result of their job, there are several different ways to be compensated for this misfortune. The injured can get their missed wages reimbursed while they are recovering, as well as their resulting medical bills. Before getting started, it’s valuable to understand that there are some job categories that are not covered by workers’ compensation. These include:

1. Coal miner matters in accordance with the Workplace Injury Management and Workers Compensation Act of 1998.
2. Dust disease matters related to the Workers’ Compensation (Dust Diseases) Act of 1942.
3. Claims made under the Workers’ Compensation (Bush Fire, Emergency and Rescue Services) Act 1987.

In order to get workers’ compensation, the affected party must file a claim with SIRA. Here are some examples of injuries or damage that could result in workers’ compensation if they happened on the job:

• Permanent impairment.
• Death.
• Property damage.
• Hearing loss.
• Serious injury or illness.
• Other dangerous incidents.

It’s important to note that an affected party can’t claim payments for pain and suffering, according to the Workers’ Compensation Act of 1987. This is because pain and suffering are non-economic damages and would not be covered by workers’ compensation, which only repays financial damages.

How to file for workers compensation

Now that you know what compensation is possible and whether you qualify or not, let’s break down the steps you need to take to file for workers’ compensation.

1. Gain evidence

The first thing you need to do is gather the necessary evidence to support your claim. According to SIRA, here is what an injured worker must prove to be eligible for compensation:

• The work injury must be the direct result of employer negligence.
• You must have at least 15% permanent impairment (assessed by a permanent impairment assessor with qualifications, training and experience relevant to the body system being assessed). This assessment will also have to be accepted by the insurer or determined by the Workers’ Compensation Commission.
• You have received all statutory lump sum entitlements for permanent impairment to which you are entitled. This must take place before a work injury damages claim can be settled.

2. Notify employer

After you have sufficient evidence — or while you are in the process of gathering it — the employer must be notified, either verbally or in writing. You must alert them as soon as you know about the harm inflicted, usually, before three months have passed. The employer then has 48 hours to make sure that their insurance company is aware of the accident. The following is what should be included when ensuring that the employer knows about the injury:

• Name and contact details (including a phone number and postal address).
• Employer’s business name and contact details.
• The treating doctor, including their name and address of the medical centre.
• Injury information, including date of the injury or the period over which the injury emerged, when the injury happened, and descriptions of how the injury happened and the injury itself.

3. Work with lawyers

Now that the employer is aware of the impending workers’ compensation claim, you are one step closer to getting your payout. In most cases, the claim will be given to the Personal Injury Commission to achieve possible mediation before starting court proceedings. If some sort of an agreement isn’t reached, work injury damages claims are most often heard in the District Court. It is common for court-related fees to be included in the damages. A professional will be able to help you gather the right information and ask for the right amount. At Gerard Malouf & Partners, we have a no-win-no-fee approach.

4. Receive compensation payout

Before 2015, workers’ compensation payouts were managed by WorkCover. Now there are three different agencies that are in charge of the system:

• icare: According to their website, icare provides “workers compensation insurance to more than 329,000 public and private sector employers in NSW and their 3.2 million employees.”
• Self-insurers: This kind of insurance is employer approved by SIRA to manage their own workers compensation claims.
• Specialised insurers: Specialised insurers are licensed by SIRA to provide coverage and manage workers compensation claims for employers in a specific industry

There are several different ways that you can receive compensation depending on your personal situation. These include:

1. Weekly: This is a common way to receive compensation if you are unable to get your normal working wages as a result of a work-related injury. Note that, despite the name, you could get the compensation bi-weekly or even monthly.
2. Lump-sum: If you or someone you know has been permanently injured, you may be eligible to receive a lump sum of money for pain and suffering. If this is the action that is taken, the weekly compensation payouts must cease.

If your claim is rejected, it’s important to know where to go from there. You have a couple of options, including appealing the result. There are several reasons why your claim may be rejected:

• The person who filed is not considered a ‘worker.’
• The injury was not related to work.
• The claimed expenses are not reasonable for the injury or illness suffered.

Claiming workers compensation in NSW

Now that you understand the basics of filing a workers compensation claim, it’s time to get into the specifics.

Report the workplace injury as soon as possible

One of the most important things to do first is to make sure that workplace injury is reported as soon as possible. There is a single system that iCare uses to manage claims, which has a simple way to report the injury. You can do it via phone (at 13 77 22) or via email (newpiclaims@icare.nsw.gov.au). It can’t be stressed enough how important it is to report the injury, regardless of how small it is or whether you are certain or not it is a qualifying injury.

What do I do if the claim is rejected

In a matter of a few weeks, you should know whether or not your claim was accepted. In some situations, the case may not qualify and will be rejected. If this happens, your insurer must give you what is known as a Section 78 Notice. The notice will tell you all the reasons why it wasn’t a successful filing. In order to dispute this rejection, it’s important to have legal representation to help you.  

What is the maximum payout for workers compensation in NSW?

Every situation is different depending on the industry, the injury and the kind of requested compensation. Let’s take a look at the entitlement period and the resulting entitlements, which depend on your specific case. The calculations rely on the amount of time you are eligible. Here is a simple breakdown according to iCare.

With some work capacity:

• Weeks 14-130: 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: Weekly benefits stop for most, some exceptions apply.

With no work capacity:

• Weeks 0-13: Up to 95% of pre-accident earnings.
• Weeks 14-130: Up to 80% of pre-accident earnings.
• Weeks 131-260: Up to 80% if no work capacity is likely to continue indefinitely.
• After 5 years: Weekly payments are only available to people with WPI** >20%.

What to know about lump sum payments

Some people will be entitled to a more direct lump sum payment, which is doled out in two specific ways. One way is through a permanent impairment payout and the other way is through a work injury damages payout. The second method is also known as a common law claim that is caused by negligence.

Case study example

If you aren’t sure how to calculate your payout or if you are getting the right amount, it can be helpful to seek legal advice. At Gerard Malouf & Partners we have 35 years of experience and a 98% success rate with winning workers compensation claims, so it’s safe to say that we know what we’re doing. Use our knowledge to your advantage and be more prepared to file a claim. Let’s take a look at a real-life case that was taken care of by Gerard Malouf & Partners, so you can get an idea of what compensation to expect: In this particular case we worked with a client who was injured in the workplace after being struck by a forklift. He sustained a serious injury to his right leg, which ultimately required amputation. While our client was already receiveing payments for loss of income and medical expenses, we were able to secure a favorable lump sum settlement of an additional $2,960,000.

Australian laws that protect workers in NSW

Workers in Australia are protected by government legislation, giving them certain rights if they are ever to become injured on the job. Let’s take a look at a few of the most important pieces of legislation to know as an injured worker.

Workers’ Compensation Act

The 1987 act, along with its amendments, establishes that if a worker is injured while they are at work, the employer is liable for the resulting injury. In addition and because of the liability, the Workers’ Compensation Act ensures that the affected employed individuals receive appropriate compensation for their injury. This could be in the form of repaid lost wages, paid medical bills and other financial payouts.

Safe Work Australia

Safe Work Australia manages national policy regarding workers’ compensation. This national policy body focuses on the development and evaluation of the model WHS laws (the model laws), which are comprised of:

• Model WHS Act
• Model WHS Regulations
• Model Codes of Practice

If you or someone you know has been affected by a work-related accident, contact a professional to learn more about your first steps. Gerard Malouf & Partners lawyers have the experience and have seen many successful workers’ compensation claims, gaining compensation for our clients. A work injury lawyer from our Gerard Malouf & Partners will work to get you the highest level of work injury compensation. As experts in workers’ compensation, we can help you make the right decisions and build up your case. To learn more, contact us today.