What can I claim through WorkCover compensation?

Weekly compensation payments

These are calculated based on the income you have received in the 12 months prior to the injury. Your 'pre-injury average weekly payments' (PIAWE) are calculated and paid as below:

• Weeks 1 - 13: Paid at 95% of your PIAWE, including any overtime or shift allowances.
• Weeks 14 - 52: Paid at 80% of your PIAWE, including any overtime or shift allowances.
• Weeks 53 - 130: Paid at 80% of your PIAWE, excluding any overtime or shift allowances.

Weekly compensation payments can only continue after 130 weeks if you have no current work capacity which is likely to continue, and a whole person impairment of 21% or more.

After receiving WorkCover weekly payments for 52 weeks, the WorkCover insurer must also make superannuation contributions on your behalf.

Medical and like expenses

These include GP and specialist appointments, medical costs, surgical costs, and travel expenses to attend treatments. Other expenses may include home and gardening services, as well as vehicle and home modifications.

All expenses must be reasonable and directly related to the injury sustained, and will be determined by the WorkCover insurer.

Impairment benefit claims

These are claims for permanent impairment resulting from injury or illness. Your injury must be stable at the time of assessment, which generally means a waiting period of 12 months from the date of the injury or surgery before the assessment can be undertaken. Different types of injuries must meet specific thresholds:

• Musculoskeletal injuries to the back, neck, shoulders, knees, and ankles require a 5% whole person impairment before compensation is payable.
• Other physical injuries such as hernias, hearing loss, heart attacks, and strokes, require a 10% whole person impairment before compensation is payable.
• Psychological injuries require a 30% whole person impairment before compensation is payable.

The WorkCover insurer will arrange a medico-legal impairment assessment to determine your whole person impairment. The amount of compensation is determined by the whole person impairment percentage and is indexed annually. The impairment rating can be challenged by referring the assessment to the Medical Panels.

Serious Injury/Common law claims

Common law claims are claims brought against your employer or a third party responsible for the occurrence of your injury or illness. To succeed, you must show that your injury arose due to the negligence of your employer or the third party. This involves proving a breach of the duty of care owed to you, such as failure to address a reasonably foreseeable risk of harm in the workplace, a breach of manual handling regulations, or another failure.

To initiate a common law claim, you must first submit a Serious Injury Application. You must be assessed as having suffered one of the following:

• 30% whole person impairment.
• Permanent serious impairment or loss of a bodily function.
• Permanent severe mental or severe behavioural disturbance or disorder.

The Serious Injury Application can seek compensation for pain and suffering alone, or for both the pain and suffering and economic loss.

• Pain and suffering compensation relates to the impact of the injury on your lifestyle. There is a threshold to determine if the consequences are "serious" when compared with other claims.
• Economic loss damages can only be claimed if any residual work capacity prevents you from earning more than 60% of your pre-injury income. Your previous three years of tax returns will be used to assess your prior earning capacity.

Once the Serious Injury Application is lodged with WorkCover, the employer's or defendant's lawyers have 120 days to accept or reject the application. If accepted, a conference is held to attempt settlement of the claim. If rejected, proceedings may be issued in the County Court of Victoria for the Court to make a determination.

Maddens Lawyers are the personal injury compensation experts

As you can see, WorkCover claims can range from a short period of weekly payments to more complex cases involving compensation for significant injuries. At Maddens Lawyers, we have the knowledge and expertise to assist you, no matter the extent of your claim. Speak to one of our team today and let us help you get the compensation you deserve.

Written by Personal Injury Senior Lawyer, John Cramp