Life can be difficult after you’re injured at work. From driving to dropping the kids at school, basic daily tasks can become a lot more challenging when you’re trying to recover from an injury. One of the trickiest things to stay on top of are essential domestic tasks like cleaning, washing and maintaining the home and garden.
Under section 60AA of the Workers Compensation Act 1987 (‘the Act’), an injured worker is able to claim domestic assistance that is ‘reasonably necessary’ through their employer’s insurer, even if it’s provided ‘gratuitously’ – that is, provided free of charge by friends and family.
There are, however, a number of conditions before domestic assistance will be provided as part of a workers’ compensation insurance claim. It’s important to have your evidence properly prepared before making a claim for the costs of domestic assistance, and in the event the insurer rejects the claim. In this case it’s important to consult legal professionals with expertise in compensation law to help expedite your claim.
What is the criteria for making a claim for domestic assistance?
The Act lists the following four requirements to apply for compensation for domestic assistance:
- A medical practitioner certifies that it is reasonably necessary that the assistance be provided. Necessity is assessed on the basis of a functional assessment, and the medical practitioner must be of the opinion that the necessity arises as a direct result of the injury.
- The assistance would not be provided but for the injury, meaning that before you suffered the work injury, you did not need the assistance.
- The injury has resulted in a degree of permanent impairment of the worker of at least 15 per cent, or the assistance is to be provided on a temporary basis. Under section 60AA(2) of the Act, ‘temporary basis’ means the care is provided:
- For not more than 6 hours per week, and;
- For not longer than 3 months, and:
- It is provided pursuant to requirements of the relevant injury management plan.
- The domestic assistance is provided in accordance with a care plan established by the insurer (which must accord with SIRA iCare Guidelines).
How is gratuitous care claimed?
In cases where a family member or other close relative provides gratuitous (i.e. free) domestic assistance, it’s possible to claim the cost only if the person who provided the assistance lost income or took time off work to do so. Family members who would otherwise have been at home cannot, therefore, be paid for the domestic assistance.
Section 60AA(5) of the Act sets out the conditions under which payments for gratuitous assistance will be made:
- payments for domestic assistance are made only as the costs are incurred, or for gratuitous domestic assistance, as the services are provided;
- the payments will only be made if the costs of the domestic assistance and the provision of the assistance is properly verified;
- any payments for gratuitous domestic assistance will be paid directly to the provider of the assistance.
What to do if your claim for domestic assistance is challenged?
Once a claim for domestic and/or gratuitous assistance as part of a workers’ compensation claim is made, the insurer is obligated to make a decision on the claim within 21 days. Missing this deadline entitles the employee to file a complaint with NSW’s Independent Review Office – the government agency that handles disputes between injured workers and insurance companies – or lodge a dispute in the Personal Injury Commission.
In some cases, an insurer may deny the claim for domestic or gratuitous assistance on any number of grounds. If this is the case, contact our award-winning team of compensation lawyers at BPC Lawyers.
After consulting with you on the circumstances of your case, we can approach the insurer to conduct an internal review of the decision in the quest to overturn it, and/or commence proceedings on your behalf at the Personal Injury Commission for an independent decision on the merit of the claim.