Injury Management Guide

Suffered an injury as a result of work? Need expert representation?

After my accident the claims process was overwhelming. The insurer was difficult to deal with and I didn’t know who to trust. They offered me peanuts for my claim. I was lucky to find you. Thank you for all the help, you were honest and upfront from the start and the result was superb. All the very best to you and your staff. Marni, Narellan Vale

All employees in New South Wales are covered by workers compensation insurance in the event of an injury which occurs during the course of their employment.

BPC Lawyers endeavour to obtain favourable outcomes and to protect the rights of Sydney’s injured workers.

Don’t delay! Contact our Workers Compensation Specialists today.

Suffered an injury at work and struggling to get proper Workers Compensation Claims?

Contact BPC Lawyers at (02) 8280 6900 to get free legal consultation.

If a worker is injured an employer must:

  • Attend to the injured worker as soon as possible;
  • Notify the insurance company within 48 hours;
  • Co-operate and participate with the insurance company to develop an injury management plan;
  • Implement and monitor a return to work plan for the injured worker.

Obligation of an injured worker

An injured worker must accept suitable duties if offered. The workers compensation benefits will be stopped if you do not accept the suitable duties. You must comply with the injury management plan and a return to work plan and must in good faith attempt to return to work. If the insurance company can demonstrate that you have not sought suitable employment and you are fit to do so, then your payments can be stopped.

Role of the treating medical practitioner

The primary role of the medical practitioner or the nominated treating doctor is to oversee the medical management of a worker. The insurer has no right to tell a nominating treating doctor what treatment can or can not be provided. The insurer can only decline to pay for such treatment if it does not consider it is reasonable and necessary.

The nominated treating doctor is to provide a medical certificate that accurately reflects the workers’ level of fitness for work based on the doctor’s clinical opinion.

It is the doctor’s responsibility to determine fitness for work, not the insurer or a rehabilitation provider. Often a rehabilitation provider places undue pressure on the doctor to complete a medical certificate which certifies the worker fit for a particular type of work. This behaviour is against the intention of the Legislation and your solicitor should be notified immediately if this occurs.

A nominated treating doctor is also responsible for providing information to the insurer, the rehabilitation provider and other treating practitioners to assist in the worker’s management and return to work.

You are allowed to change your nominated treating doctor and approval should be sought from the insurer prior to this occurring.

Injury management plan vs. return to work plan

There are two types of plans intended to help you recover and return to work as soon as possible.

One is drawn up by the insurance company and is called an “Injury Management Plan”, the other is written by a rehabilitation provider and is called a “Return to Work Plan”.

1.  Injury Management Plan

The insurance company is required to consult with the injured worker, the employer and the treating doctor prior to developing the injury management plan.

The injury management plan outlines all the services required to return the worker to the workplace. After establishing an injury management plan, the employer and the injured worker receive a copy of the plan from the insurance company and they both have an obligation to comply with it.

2.  Return to Work Plan

The return to work plan is usually a written formal offer of suitable duties by the employer to the injured worker. It is designed to make clear what the worker can and can not do when they return to work. The plan must be agreed by all relevant parties including you, your supervisor, nominated treating doctor and rehabilitation provider.

Suitable duties

Suitable duties are short term work duties agreed between the employer and you to assist the injured worker’s rehabilitation. Suitable duties must comply with the current medical certificate and they include:

  • Parts of the job you were doing before the injury;
  • The same job but on reduced hours;
  • Different duties all together;
  • Duties at a different site;
  • Training opportunities;
  • Or a combination of all of the above.

The definition of suitable duties states that the following must be taken in to account:

  • The Medical Certificate in which the treating doctor will list your capabilities;
  • Your age, education and work skills;
  • Where you live;
  • The duties must be useful to the employer’s trade or business;
  • The duties must comply with the injury management plan; and
  • The duties must not be demeaning or token jobs.

Must an employer always provide suitable duties to an injured worker?

The answer to this question is yes. In practice however this does not always occur. The reality is that an employer must provide suitable duties if it is reasonably possible to do so.

If the employer fails to provide suitable duties it will effect the employer in two main ways:

  • The cost of the claim will increase as a worker is entitled to special weekly compensation benefits (pursuant to Section 38) for up to 52 weeks.  This will increase the cost of the workers compensation premium on the employer.
  • The Workers Compensation Commission can impose a penalty of up to $5,000.00.

An employer does not need to provide suitable duties if you voluntarily resign or employment is terminated for reasons other than the injury.

Can I Sue My Employer?

Ordinarily, the law requires you to bring this kind of cause of action within 3 years of its occurrence.

However, when suing your employer, the Court is given the power to extend this time. Traditionally it would grant such an extension provided that it was satisfied a fair trial would be conducted; that is, that the Defendant was not materially prejudice by the delay in bringing the action out of time.

READ MORE

How To Make A WorkCover Compensation Claim

The definition of a worker includes:

Those that work for an employer as an employee under a written or oral contract of service;
A “deemed” worker, that is contractors who should be treated as employees.
If you fall in to one of the above categories and have sustained an injury either in the course of your employment or either travelling to or from work then you are entitled to make a claim for compensation. Mostly it does not matter whose fault it was that caused the injury.

READ MORE

Workers’ Injury Management Guide.

If a worker is injured an employer must:

Attend to the injured worker as soon as possible;
Notify the insurance company within 48 hours;
Co-operate and participate with the insurance company to develop an injury management plan;
Implement and monitor a return to work plan for the injured worker.

READ MORE

An Expert Workplace Injury lawyer Will Help Advise You On.

  • Gathering medical records and relevant evidence
  • Refuting the claims of any independent doctors from WorkCover
  • Whether you have the right to seek additional medical opinions to help support your claim
  • Who is liable to pay for the medical reports and bills; including any union assistance

If you have suffered a work-related accident, don’t be afraid you will be fired. It is actually within your employer’s best interests to keep you employed and to comply with the accident compensation claim. So speak to an expert workers compensation lawyer at BPC early, to help clarify your rights and your employer’s legal obligations to compensate your injury.

If your accident occurs due to the fault of your employer or some third party you may have a right to bring a common law claim for damages. This type of claim may be far more substantial than your WorkCover claim. Our experienced team of personal injury lawyers can advise you of your rights and entitlements and ensure you get the compensation you deserve.

Are You Covered and What Are You Entitled To

In New South Wales the Workers Compensation Act provides financial protection to all workers in the event that they are injured or killed at work or suffer a work related disease.

The act states that a worker, who has received an injury at work, shall receive compensation from the worker’s employer. In the event that the injury results in the death of a worker, then the worker’s dependents shall be entitled to receive this compensation.

If you are injured at work you will be entitled to receive workers compensation which includes:

  • The payment of weekly compensation benefits until you are able to return to work.
  • The payment of your reasonable and necessary medical bills for treatment you require as a consequence of your work place injury including physiotherapy.
  • The payment of any costs associated with your rehabilitation to enable you to return to work including retraining if you are no longer able to continue doing the same work as a result of your work place injury.
  • Lump sum payments of compensation if you have suffered a permanent impairment of a certain level.
  • Lump sum payments of compensation for pain and suffering if your work place injuries are assessed at a certain level.
  • Payment of your legal expenses incurred in making a claim for compensation.

Workcover Insurance

The Workers Compensation Act makes it compulsory for employers to have a workers compensation policy if they pay more than $7500 in wages per annum, employ an apprentice or trainee, or are part of a group for premium purposes.

These policies of insurance are called “WorkCover Insurance”.

WorkCover NSW is part of the Compensation Authorities Staff Division. The Division was formed as an administer for work health and safety, injury management, return to work and workers compensation laws and manage the workers compensation system.

The aim of WorkCover Insurance is to ensure that all workers will receive their statutory entitlements to workers compensation if they suffer a workplace injury, regardless of the financial status of their employer. Employers pay a premium each year for their WorkCover insurance depending on the number of employees they employ and various other factors.

If you are injured at work you will be entitled to receive workers compensation which includes:

  • The payment of weekly compensation benefits until you are able to return to work.
  • The payment of your reasonable and necessary medical bills for treatment you require as a consequence of your work place injury including physiotherapy.
  • The payment of any costs associated with your rehabilitation to enable you to return to work including retraining if you are no longer able to continue doing the same work as a result of your work place injury.
  • Lump sum payments of compensation if you have suffered a permanent impairment of a certain level.
  • Lump sum payments of compensation for pain and suffering if your work place injuries are assessed at a certain level.
  • Payment of your legal expenses incurred in making a claim for compensation.

Workers Compensation Changes in NSW

The NSW Workers Compensation scheme has recently undergone some radical changes.

These changes have/will apply to ALL workers regardless of when their injury occurred UNLESS

  • You were injured whilst and as result of employment with NSW Ambulance employee
  • You were injured whilst and as result of employment with NSW Police
  • You were injured whilst and as result of employment with NSW Fire Brigade
  • Your claim is covered by a ComCare System or another state scheme.

The Old System
Generally, the old System provided all workers the following ongoing rights:

  • Payment for all medical expenses properly incurred because of a work related injury
  • Payments (capped) for time off work due to work related injury, and
  • Payment for permanent impairment suffered because of a work related injury including a sum for pain and suffering between $0.00 and $50,000.

New Restrictions
For most workers, the new system provides for many restrictions which must be considered.

Medical Expenses
Payment of medical expenses is limited in two very limited respects.

Firstly, pre-approval is required from the insurer before they are liable for the medical expense

Secondly, you can only recover medical expenses up to 12 months from your last receipt of weekly wage compensation benefits.

Hearing Loss Claims
As most workers who are suffering a hearing loss don’t have much time off due to their injury, coverage for medical expenses only lasts for 12 months from the claim being made.

This is a significant reduction in medical expenses, especially as most workers require new hearing aids etc. past 12 months.

You should therefore ensure that you obtain all the treatment you can within 12 months of your claim being made.

Weekly wage compensation
For most workers, such benefits have increased in the amount per week (cap) but decreased the duration of the entitlement to such benefits.
For most workers, this benefit will be limited to a period of 1 to 260 weeks.

If a person is seriously injured and receives an assessment of or in excess of 21% Whole Person Impairment, those benefits may extend from 261 to entitlement to the aged pension.

Permanent Impairment Benefits
One and One claim only can be made.

If your condition gets worse – you are unable to claim a ‘top up’.

Further, compensation for pain and suffering is no more.

You must have an 11% WPI or greater rating/assessment before you’re entitled to any permanent impairment compensation.

Seriously injured – the exception
If you have a 31% WPI or greater then, your entitlements to weekly wage compensation and payment of medical expenses will continue similar to before.

What should I do?
If you made a claim for compensation before 18 June 2012 and have not yet received permanent impairment benefits or feel you condition has become worse since you last assessment, please contact our office to arrange an appointment as soon as possible.

How To Make a Workcover Claim

 

The workers compensation system is run by the WorkCover Authority of NSW.  WorkCover NSW is a statutory authority within the Minister for Commerce’s portfolio. The primary objective is to work in partnership with the New South Wales community to achieve safe workplaces, effective return to work and security for injured workers.

Find out more about your eligibility to make a claim, claim application steps and all relevant information by reading our full workers’ compensation claims guide.

Workers Injury Management Guide

Injury management is the prompt, safe and long term return to work of an injured worker. It attempts to include the treatment of your injury, rehabilitation back to work, retraining into a new skill or new job and liaison with your employer.

Everyone involved in your claim is required to cooperate and participate in injury management including the insurance company, employer, yourself and your treating doctor. Both you and your employer have responsibilities and rights in relation to injury management. Find out more by reading our complete guide to injury management.

Can I Sue An Employer?

The New South Wales Worker’s Compensation Scheme is a State Government funded scheme.

As a trade-off to having to prove fault, the scheme gives employees the right to compensation for injuries suffered caused by their work.

Am I eligible to sue?

An injured worker can still bring proceedings against its employer for their loss of wage/earning capacity in negligence, breach of a statutory duty or contract if the following can be established:

  1. That your injures suffered as a result of your employment have caused you a 15 % Whole Person Impairment or greater;
  2. That your injures were suffered because of your employers negligence;
  3. You have suffered some form of economic loss that is a loss of wages and or diminution of your earning capacity.

Explore more about what suing your employer will compass and gain additional insights by reading a past workers’ compensation case.